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Fetal-Surgery “Fetal surgery itself is a relatively new procedure with only a few hundred attempts world wide. Because of the risk of inducing preterm labor and delivering so early in the pregnancy, fetal surgery traditionally was reserved for life- threatening circumstances. While spina bifida is not necessarily life- threatening, it is the most common debilitating birth defect, diagnosed in about one of every 1,000 here in the US. Babies born with spina bifida typically experience one or more lifelong and an sometimes devastating physical disabilities like weakness or paralysis in their lower limbs, loss of feeling, urinary and bowel dysfunction, and hydrocephalus (water on the brain). In addition some children also have skeletal deformation, sexual dysfunction, and mental impairment. Each child is an individual with differing degrees of disability. ‘If we have the chance to lessen the extent of injury, why wouldn’t we do that,’ asks Dr. Joseph Bruner, Director of Fetal Diagnosis and Therapy at Vanderbilt.” (http://www.fetal-surgery.com/; 10/29/00; Copyright 1998-2000 fetal-surgery.com). “Fetal surgery for spina bifida is intended to decrease the handicaps associated with spina bifida by protecting the fetuses previously exposed spinal tissue from additional damage by the amniotic fluid and intrauterine movement. Doctors say this procedure can not restore neurological function which has already been lost, but it may prevent additional loss from occurring due to the intrauterine environment.” (http://www.fetal-surgery.com/; 10/29/00; Copyright 1998-2000 fetal-surgery.com). “As an added and unexpected benefit, it was discovered that the procedure apparently affects the way the brain develops in utero, allowing certain malformations of the brain, typically associated with spina bifida to correct themselves. ‘It’s extraordinary that the malformation goes away,’ Dr. Scott Adzick told the Philadelphia Inquirer. Because of the malformation, traditionally more then 90% of children with spina bifida required a shunt to drain fluid off the brain. ‘Shunts are bad news.’ Adzick said. ‘The average kid needs three or more in a lifetime.’ Research appears to indicate that children whom have had fetal surgery for spina bifida, are less likely to require a shunt. Perhaps a 33% to 50% reduction in the need for shunts.” (http://www.fetal-surgery.com/; 10/29/00; Copyright 1998-2000 fetal-surgery.com). “’No shunts or fewer shunts is a significant benefit to patients, hospitals and insurance companies,’ says Dr. Joseph P. Bruner, director of fetal diagnosis and therapy at Vanderbilt. ‘It will decrease the overall rate of hospitalization and care these children receive.’” (http://www.fetal-surgery.com/; 10/29/00; Copyright 1998-2000 fetal-surgery.com). “Certain risks must be considered with any surgery. In fetal surgery, there are separate risks for the mother, and for the fetus. Risks to the mother may include, infection, blood-loss leading to transfusion, genstational diabetes, weight-gain due to bed rest. The mother can assume that all future pregnancies will need to be delivered via c-section.” (http://www.fetal-surgery.com/; 10/29/00; Copyright 1998-2000 fetal-surgery.com). “Of all the risks to the fetus, the risk of complications due to premature delivery top the list. Depending on the gestational age at delivery, premature babies are at risk for lung immaturity, blood transfusion, brain hemorrhage, organ immaturity, and the risk of death. Because fetal surgery for spina bifida is so new, unforseen, unimaginable, and numerous unanticipated other problems could arise.” (http://www.fetal-surgery.com/; 10/29/00; Copyright 1998-2000 fetal-surgery.com). “How is the surgery done… Simply put, fetal surgery for spina bifida requires the mother to undergo surgery to expose the fetus. Then a neurosurgeon carefully closes the lesion on the baby ‘s back(myelomeningocele). The fetus is then closed back inside the womb, the mother is sewn up, and the pregnancy continues.” (http://www.fetal-surgery.com/; 10/29/00; Copyright 1998-2000 fetal-surgery.com). “USCF is performing the surgery similarly, using an endoscopic approach, verses the open womb approach currently used at CHOP and Vanderbilt. There is research to suggest endoscopic surgery offers less risk of premature delivery, however it remains to be seen (via research) if endoscopic closure of the unprotected myelomeningocele offers the same benefits as the more complex, hands-on approach via an open womb.” (http://www.fetal-surgery.com/; 10/29/00; Copyright 1998-2000 fetal-surgery.com). “To-date, the procedure has been performed at three locations in the world, Vanderbilt University Medical Center (VUMC) in Nashville, and Children’s Hospital Of Philadelphia (CHOP), and the University Of California in San Francisco (UCSF). UCSF did a surgery, then stopped doing fetal surgery for spina bifida, and then quietly has begun doing them again. ‘We decided that we wouldn’t do that (unless) we could get far enough to do it endoscopically, and that turns out to be technically very challenging,’ says UCSF’s Dr. Harrison. These three hospitals are three of only a small handful locations in the world currently offering fetal surgery for any reason.” (http://www.fetal-surgery.com/; 10/29/00; Copyright 1998-2000 fetal-surgery.com). Word Count: 759

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