Fetal surgery allows doctors to treat certain abnormalities of the fetus that might otherwise be fatal or cause significant problems if permitted to progress.
Purpose
Approximately 3% of babies born in the United States each year have a complex birth defect. Parents are often left with the options of choosing to abort the fetus or treat the condition after birth. Certain birth defects, however, are complicated by the labor and delivery process; others may progress quickly after birth to cause significant disability or death. Fetal surgical techniques offer early intervention in order to treat such defects before they become more serious. The first open fetal surgery took place at the University of California at San Francisco (UCSF) in 1981.
Some of the fetal abnormalities that may be treated by fetal surgery are:
Myelomeningocele. Also called spina bifida, myelomeningocele is a condition in which the spine fails to close properly during early fetal development. The spinal cord may protrude or be exposed through an opening in the lower back. Paralysis, neurological problems, bowel and bladder problems, and hydrocephalus (fluid buildup in the brain) may result. Myelomeningocele affects one out of every 1,000 babies born in the United States.
Congenital diaphragmatic hernia (CDH). In babies with CDH, the diaphragm (the thin muscle that separates the chest from the abdomen) doesn't develop properly. The abdominal organs may enter the chest cavity through a hole (hernia) and cause pulmonary hyperplasia (underdeveloped lungs). CDH occurs in about one out of every 2,000 births.
Urinary tract obstruction. The urethra (the tube that carries urine from the bladder to the outside of the body) may become obstructed in utero or fail to develop normally. When this happens, urine can back up into the kidneys and destroy tissue or cause the bladder to become enlarged. The amount of amniotic fluid also decreases because fetal urine is its major component. Pulmonary hypoplasia usually results because the lungs rely on amniotic fluid in their development.
Congenital cystic adenomatoid malformation of the lung (CCAM). CCAM is a large mass of malformed lung tissue that does not function properly. As a result of its large size, it may put pressure on the heart and lead to heart failure. Lung development is also affected, and pulmonary hyperplasia may result.
Twin/twin transfusion syndrome (TTTS). In some twin pregnancies, the two fetuses will share a placenta. TTTS occurs in approximately 15% of these twins when blood volume between the fetuses is unequal, causing abnormally low blood volume in the donor twin and abnormally high blood volume in the "recipient" twin. There is often a large difference in size between the twins. Approximately 70–80% of fetuses suffering from TTTS will die without intervention.
Sacrococcygeal teratoma (SCT). This usually benign fetal tumor develops at the base of the spine (coccyx) and affects approximately one in 35,000 to 40,000 newborns in the United States. The tumor may become very large (sometimes as large as the fetus) and filled with blood vessels, causing stress on the heart.
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