Prenatal Surgery We are living in the age of medical breakthroughs and advances in technology. With the advancement of ultrasound, this allowed doctors to view the fetus in great detail. Doctors now are alerted to fetal anomalies and are given the opportunity to correct them before childbirth. One of these major advances is prenatal surgery. Prenatal surgery is a surgical procedure performed on a fetus prior to birth. Prenatal surgery, also called fetal surgery, antenatal surgery, or maternal-fetal surgery is performed under circumstances in which the fetus is not expected to live long after birth without prenatal intervention.
Prenatal surgery usually requires a general anesthetic, although sometimes an epidural anesthetic to numb the abdominal region may be used. The fetus receives the anesthetic via the mother’s blood. An anesthesiologist and a perinatologist monitor the heart rates of the mother and fetus during the procedure. (“thefreedictionary. com”) The first successful fetal operations were carried out in the 1920’s on various animal subjects. The first human fetal surgery was performed in 1963. The surgery was a blood transfusion to the fetus with the condition “Rh incompatibility”.
This condition means the fetus’s Rh- positive red blood cells are being destroyed by its Rh- negative immune system. The surgery was performed by A. William Liley in Auckland, New Zealand, he used x-rays to see the fetus and guide his needle. (“http://science. jrank. org/pages/5466/Prenatal-Surgey-History-fetal-surgery. html”) With the introduction of the ultrasound machine, a doctor could bounce sound waves into the pregnant woman’s abdomen and create an image of the fetus on a TV-like screen. (“http://science. jrank. org/pages/5466/Prenatal-Surgey-History-fetal-surgery.html”).
Amniocentesis made way for genetic testing to determine other genetic diseases. Having these new tools for prenatal diagnosis now makes it possible to identify fetal abnormalities. On April 26th, 1981, the first human open fetal surgery in the world was performed at the University of California, San Francisco under the direction of Dr. Michael Harrison. (“American Association for the Advancement of Science” 72) The fetus had a congenital hydronephrosis, a blockage in the urinary tract that caused the bladder to dangerously extend.
Great advances have been made over the years since the first operation. New techniques, advances in knowledge and improvements in equipment are making way for more opportunities for the treatment in other birth defects. Prenatal surgery becomes an option if your doctors predict that the fetus will not live long enough to make it to delivery or live long after birth. The types of prenatal surgery are Open Fetal Surgery, a hysterotomy also known as a cesarean section, is performed and the fetus is partially removed so the area that needs surgery is exposed.
Fetoscopic surgery uses minimally invasive techniques; this type of surgery is used more often than open surgery. Surgeons use fiber optic telescopes and specially designed instruments to make small surgical openings without having to make major incisions or removing the fetus from the womb. Fetoscopic surgery is less traumatic and reduces the chances of preterm labor. The most common fetal surgeries are for conditions in which the child will not be able to breathe on its own after birth.
More common surgeries are uninary tract obstructions in male fetuses; this is caused by a narrowing of the urinary tract. (Alic) This narrowing causes the urine to back up and injures the kidneys. Congenital diaphragmatic hernia (CDH) occurs when the diaphragm does not form completely at about eight weeks of gestation, leaving a hole in the muscle that separates the chest and the abdomen. (Alic) Through this hole the stomach, intestines, spleen, liver and kidneys can move through into the chest cavity.
Congenital cystic adenomatoid malformation (CCAM) occurs when one or more lobes of the lungs develop into fluid filled sacs called cysts rather than into normal lung tissue. (Alic) These cysts can limit lung development and can cause heart failure because the cysts push into the heart. Sacroccygeal teratoma (SCT) is the most common tumor in newborns, occurring in one out of every 35,000 to 40,000 births. (Alic) This tumor is more common in girls than boys. These tumors are at the base of the tailbone and can grow very large.
Up to 15 percent of twins who share a placenta called monochorionic twins have twin – twin transfusion syndrome (TTTS). (Alic) Twin-twin transfusion syndrome is caused by abnormal blood vessel connections in their shared placenta. One baby the recipient twin, gets too much blood overloading his or her cardiovascular system, and may die from heart failure. (“www. fetalhope. org”) The other baby, the donor twin or stuck twin, does not get enough blood and may die from severe anemia. (“www. fetalhope. org”).