The Benefits of In Utero Spina Bifida Surgery
In the United States, more than 1,500 babies are born every year with a condition known as spina bifida, a congenital condition that occurs when the spinal cord does not develop normally (neural tube defect). The lack of protective structures such as bone, muscle and skin exposes the spinal cord and nerves to the amniotic fluid in the womb, making them susceptible to damage. In many cases, spina bifida is diagnosed in utero with a sonogram as early as 18 to 20 weeks.
Depending on the severity of the condition, symptoms for children born with spina bifida can range from almost no symptoms or symptoms that don’t appear until later in life, to an inability to walk or have feeling in the legs or feet, and even the buildup of spinal fluid in the brain.
Historically, babies born with spina bifida have undergone surgery to close the neural tube and reconstruct the spine shortly after delivery. However, once damage to the nerves has occurred, it can’t be reversed, so any neurological damage that occurred in utero was likely permanent.
Benefits of Fetal Surgery
In recent years, however, in utero surgery techniques have been developed to repair the spinal defect between 19 and 26 weeks of gestation, which was proven to reverse the neurological damage that would have occurred during the remainder of the pregnancy. In fact, the study showed that babies who undergo fetal spina bifida surgery in the womb have much better neurological outcomes than those who are operated on after delivery.
During surgery, a team of surgeons works together to interrupt the damage to the spinal cord and brain while it’s developing inside the womb. We repair the spinal defect and re-establish its protective coverage. This can reverse some of the early neurological damage that has already happened and stop any further damage. It also interrupts the buildup of spinal fluid inside the brain. As a result, we get the best possible outcomes and give the baby the best chance at normal neurological function.
Babies who have the surgery done in the womb typically have less severe symptoms. For example, they may be able to walk with braces, as opposed to needing a wheelchair on a long-term basis. It also reduces the risk of spinal fluid building up in the brain by 50 percent, so they are less likely to need surgery to drain the fluid and relieve the pressure.
Who Is Eligible
When spina bifida is detected during a sonogram, a mother is referred to a fetal surgery center, such as the Fetal Care Center at Orlando Health Winnie Palmer Hospital for Women & Babies, for a comprehensive evaluation to see if she and the fetus are candidates for the surgery. Typically, the mother and fetus must otherwise be in good health to qualify for in utero spina bifida surgery.
After a thorough examination determines they are a candidate, we present the surgery to the mother as an option. At that point, it’s her decision and we will support her no matter what she decides.
Ultimately, the goal of the surgery is to allow the child to live a life as free from complications as possible.
“During surgery, the baby is partially extracted from the uterus or the womb,” says Dr. Cole Greves, a maternal-fetal medicine physician at Orlando Health Winnie Palmer and part of the Fetal Care team. “They are still attached to the mother via the umbilical cord, which provides nutrition and oxygen, as well as anesthesia, to the baby. So, in some families, they consider that as an additional delivery and celebrate the date with a birthday. Which is nice.”
Choose the Best Care for Your Unborn Baby
At the Fetal Care Center at Orlando Health Winnie Palmer Hospital for Women & Babies, we are dedicated to helping families when prenatal conditions are diagnosed. We are here to assist your family from diagnosis and prenatal care through fetal surgery, delivery and care after birth.Learn More