Foetal surgery

Posted on 12 February 2015

There are few things more distressing for parents-to-be than to hear that their unborn baby has been diagnosed with a disorder. Thanks to hi-tech developments in surgical techniques, though, today surgeons can intervene to remedy the situation – before the baby is even born!

Foetal surgery has evolved rapidly since the first procedure was carried out in the US 30 years ago. With high-resolution prenatal ultrasound and other testing, it’s easy for paediatricians to spot any foetal abnormalities early. The treatment of most problems can wait until the baby is born, but there are a few conditions where it’s necessary to intervene before birth – to save the life of the baby, or prevent permanent organ damage.

Dr Linnie Muller, head of the Panorama Fetal Medicine Centre, explains the basics:

How does foetal surgery work?
During foetal surgery, the mother is given an anaesthetic, the uterus is opened, the foetus is either partially or completely taken out of the womb, surgery is done, then the baby is returned to the uterus and the incision is closed. Warmed fluids are continuously infused into the uterus to keep the amniotic fluid level safe for both mother and baby.

In which areas of foetal surgery is the most encouraging progress occurring?
Some of the greatest successes are in:
• Open surgery, which we use to correct certain types of spinal abnormality, known as spina bifida.
• Needle-based therapy, to allow foetal blood transfusions through the umbilical cord or to drain excess fluid from the foetal chest or bladder.

We also spoke to Dr Lou Pistorius, a maternal and foetal medicine specialist at Mediclinic Panorama. The groundbreaking development in foetal surgery known as the EXIT procedure was the subject of a DStv Carte Blanche programme in January 2015.

What is the EXIT procedure?
The EXIT procedure (ex-utero intrapartum treatment) is a highly specialised surgical procedure used to deliver babies who would be at risk after birth because of potential compression of the airway – which would prevent them from breathing. It is similar to a standard Caesarean section, except that when the opening is made into the mother’s abdomen and uterus, the baby is only partly delivered through the opening and remains attached by the umbilical cord. Once the EXIT procedure is complete, the umbilical cord is clamped and cut, and the baby is fully delivered.

What other developments in foetal surgery can you tell us about?
At Mediclinic Panorama we have also started foetoscopic laser surgery for monochorionic twins (identical twins sharing a placenta) where the pregnancy is complicated by twin-to-twin transfusion syndrome (TTTS). We are also very excited about our plans to implement a real-time link with a university in the Netherlands, with the aim of shortening our learning curve and improving the quality of the surgery even more.

Mediclinic continues to be at the forefront of medical research and world-class expertise. So you can relax – you and your baby are in good hands!

The information provided in this article was correct at the time of publishing. At Mediclinic we endeavour to provide our patients and readers with accurate and reliable information, which is why we continually review and update our content. However, due to the dynamic nature of clinical information and medicine, some information may from time to time become outdated prior to revision.

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