Prenatal Surgery Now Possible to Correct Spina Bifida
A new study released by the National Institutes of Health and published in The New England Journal of Medicine revealed fetal surgery (surgery performed on a fetus while it’s still in the uterus) is now possible to reduce complications from spina bifida after birth.
Spina bifida is a common birth defect where the fetus’s spine does not form fully or close completely around the spinal cord, often leaving an opening in the vertebrae. Babies born with various types of spina bifida are at risk for dangerous excess brain fluid, brain and physical deformities, loss of bladder control, trouble walking, and paralysis.
Traditionally, postnatal surgeries (surgeries after birth) are performed to correct spina bifida, which includes using a tube (shunt) to drain the fluid. Now, by closing the opening during fetal surgery, the chance for excess brain fluid can be reduced and the ability to walk without crutches, braces, or other orthotics can be increased.
For the study, 183 mothers who had fetuses with myelomeningocele volunteered for the study. Myelomeningocele is the most severe form of spina bifida where the spine protrudes through an opening in the spinal column and is enclosed in a fluid-filled sac. The women were divided randomly into two groups: one group underwent prenatal surgery (at 26 weeks of pregnancy) while the other underwent postnatal surgery.
Once all the babies were born, doctors followed their progress after 12 months and then again after 30 months. Compared to the group that had postnatal surgery, the group that had prenatal surgery showed better results: fewer babies died or had hindbrain herniation (when the base of the brain is pulled into the spinal cord), fewer babies required a shunt, and more babies were able to walk on their own.
However, the group that had prenatal surgery was at higher risk for preterm birth, increasing the chance for respiratory distress syndrome in babies. Mothers in the same group also had a higher risk of uterine dehiscence (the thinning or tearing of the uterine incision made for the surgery) during birth which meant cesareans were required for future births.
While some doctors speaking to The New York Times would not recommend prenatal surgery because of the potential risks still involved, the opportunity to reduce other risks and outcomes of spina bifida is now more available than 10 years ago.
Read more on prenatal surgery:
- The New England Journal of Medicine: Fetal Surgery
- The New York Times: Success of Spina Bifida Surgery
- Centers for Disease Control: Facts About Spina Bifida