Few parents have to face the prospect of their baby being born with serious birth defects. But for babies with any of about a dozen specific disorders, treatment before birth can improve their health. While prenatal surgery is the most dramatic example of how the new field of fetal medicine is saving babies, many more children have been helped by other less risky procedures. Find out how these measures could save your child.
If you're considered at risk for delivering prematurely, your doctor may recommend prenatal injections of drugs, called corticosteroids, aimed at speeding the development of your baby's lungs and other organs. Risk factors for early labor include preeclampsia, diabetes, or third-trimester bleeding. Since 1994, the use of corticosteroids has reduced preemie infant deaths by about 30 percent and has cut the rates of two serious complications: respiratory distress syndrome (by 50 percent) and bleeding in the brain (by 70 percent).
A less common problem, abnormal fetal heart rhythm, can also be corrected with prenatal medicine. Your doctor can diagnose a heart arrhythmia only 10 to 12 weeks into pregnancy by listening to your baby's heart and then following up with more detailed ultrasounds. To treat it, medicine is either given to the mother or delivered directly into the fetus's bloodstream via a technique called cordocentesis. Guided by ultrasound, the doctor inserts a thin needle through the mother's abdomen and into a tiny blood vessel in the umbilical cord, then injects the drug.
A blood transfusion while still in the womb can help a fetus with severe anemia resulting from Rh disease (an incompatibility between the blood of the mother and her fetus that causes destruction of the baby's red blood cells). Transfusions are usually given using cordocentesis and can begin as early as the 18th week of pregnancy, saving more than 90 percent of these babies. Fortunately, Rh disease is rare today; women who have the Rh-negative blood associated with it are routinely given shots of a substance called immunoglobulin, which usually prevents the disease in their babies.
A technique similar to cordocentesis can also transplant bone marrow cells into fetuses who would otherwise be born with certain life-threatening immune system disorders and anemias, such as sickle cell.
Closed-uterus fetal surgery
Closed-uterus fetal surgery, in which the baby remains in the womb while the defect is fixed, is usually performed around 28 weeks. It's most commonly used to relieve urinary tract blockages. When the blockage is severe, the bladder becomes swollen with urine, causing the fluid to back up and damage or destroy the kidneys. To correct the problem, a surgeon, guided by ultrasound, inserts a needle into the fetus's bladder. Through the needle, the surgeon puts in place a shunt that allows the bladder to drain continually until birth, when the blockage can be repaired.
Open fetal surgery
Open fetal surgery is a newer area of prenatal medicine, also performed at around 28 weeks. The surgeon makes a cesarean-like incision into the mother's abdomen and partially removes the fetus from the uterus to correct the defect.
Open surgeries have been performed to repair the following defects:
- Severe cases of spina bifida, an exposed and unprotected spinal cord
- Congenital diaphragmatic hernia, a hole in the diaphragm which allows the abdominal organs to move up into the chest
- Tumor of the lungs, fluid in the lungs, and large tumors along the spine
However, opening up the uterus mid-pregnancy poses risks for both mother and baby. Among other things, it often leads to premature labor and delivery and exposes the mother to the usual risks of surgery, like infection. For these reasons, researchers are developing new, safer techniques.
The information on this Web site is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's condition.