What is Fetal Surgery?
As part of fetal surgery, surgeons perform an operation on a baby before it is born. In spina bifida babies, the defect is closed using a similar surgical technique to closure after birth. It is then closed and the baby continues to grow and develop until birth. The results of the "MOMS trial" were published in 2011, which were based on American research. Compared to operating on babies after birth, this study examined the effect of operating on spina bifida babies in the womb. As a result of the results of that study, NHS England has commissioned two providers to provide this surgery: University College Hospitals London and University Hospitals Leuven, Belgium. This is a new treatment in the UK, so we will collect and review information on your care during pregnancy and after birth in order to assess its quality.
How can fetal surgery help?
In the MOMS study mentioned above, 77 children with spina bifida were operated on in pregnancy, while they were still in the womb. Their outcomes were compared to 80 babies who underwent surgery after birth for spina bifida. A child who was operated before birth had the following benefits: 10 Less severe Chiari II malformation (hindbrain herniation) Less need for a shunt for hydrocephalus by one year, although the effect was less significant when the ventricles were already enlarged before the operation. In those who underwent surgery before birth, leg function was better at 30 months of age, although this evidence is not conclusive. Further research should clarify this.
What are the risks of fetal surgery?
A spina bifida closure operation performed before birth can result in premature labor, premature membrane rupture, and decreased amniotic fluid. The complications of preterm delivery (birth before 37 weeks) may offset some of the benefits of the fetal surgery if it occurs too early. A baby with spina bifida is more likely to die before birth (stillbirth) than a baby without it. There are also structural defects that affect babies before birth, such as a major heart hole. No matter whether a baby has fetal surgery or postnatal surgery, they are at the same risk of dying. In the first few weeks of life, there is a very low risk of a baby losing its life due to stillbirth or death. Having a stillbirth after fetal surgery can result from the fetus not being able to tolerate the surgery, but a death after birth can result from complications related to spina bifida or hindbrain herniation. It is recommended by doctors that women deliver their babies by Caesarean section after open fetal surgery, both during the current pregnancy and in future pregnancy.