When the doctor tells you that your unborn baby has a birth defect, the pain and fear a mother feels is indescribable. But with the advancements in medicine today, there are promising solutions. One of them is fetal surgery. Although this is a complex topic, let's talk about it simply and in a way that you can understand.
Simply put, what is fetal surgery?
Fetal surgery is surgery that is performed on your baby while he is still growing inside your womb. This is sometimes called `in-utero surgery`. Think of it like a car with a problem with its engine, but instead of taking it out of the car, they fix it while it is still inside. In this, surgeons treat a problem with the baby while it is still inside the womb.
This has two main goals. One is to save the baby's life by correcting something that is threatening the baby's life. The other is to minimize the serious disabilities that may occur after birth and give the baby the opportunity to live a good life .
Why do you need to have this surgery?
Some birth defects can have very serious effects on a baby while they are still inside the womb.
For example, imagine that a large tumor has formed in a baby's lungs. As it grows, the baby's little heart begins to beat. If that happens, the heart will fail, and the baby may even die.
There are other conditions that, while not immediately life-threatening, can cause lifelong disabilities after birth. An example is spina bifida, a spinal condition. This is usually treated after the baby is born. However, if this surgery is performed while the baby is still in the womb, the damage to the nervous system can be greatly reduced. This means that the baby will be able to walk and do things on his own after birth.
The important thing is that this surgery is not performed for every birth defect. It is decided by a team of specialist doctors after carefully examining the condition of the mother and baby.
How are these surgeries performed? What are the main methods?
There are three main methods of performing fetal surgery. Doctors choose one of these methods based on the baby's condition and your health.
| Surgical method | Simple way to do it | Often used occasions |
|---|---|---|
| Open Surgery | In this, you are given anesthesia, and your abdomen is cut open, just like a cesarean section, and your uterus is removed. Then, your uterus is also cut open, and the baby is operated on while still inside. Then, the uterus and abdomen are closed again, allowing the baby to continue to grow. | For complex conditions like Spina Bifida. |
| Fetoscopic Surgery | This is a "keyhole" surgery. The surgery is performed by making very small holes in the abdomen and uterus, and inserting a camera (fetoscope) and very delicate instruments. The incisions are very small. | Conditions such as Twin-to-Twin Transfusion Syndrome and Congenital Diaphragmatic Hernia, which occur between twins. |
| Surgery performed during childbirth (EXIT Procedure) | This is a special procedure. Like a cesarean section, the uterus is opened and a portion of the baby, such as the head and shoulders, is removed without completely removing the baby. While the umbilical cord is still attached to the placenta, the baby is given any necessary treatment (e.g., to clear the airway), and only then is the umbilical cord cut and the baby completely separated. | When you feel like you're having trouble breathing because of a large tumor in your neck. |
What conditions are treated with these surgeries?
These are very rare but serious conditions. Some examples are:
- Monochorionic twin complications
- Spina Bifida (`Spina Bifida` or `myelomeningocele`)
- Congenital lung malformations
- Congenital diaphragmatic hernia
- Sacrococcygeal teratoma (a tumor that occurs at the lowest part of the spine)
- Lower urinary tract obstruction
What happens during this journey? Before and after surgery
If your baby is diagnosed with one of these birth defects, it's a very sensitive time. The medical team will monitor you and your baby very closely.
Before surgery:
- Diagnosis: First, specialists use scans and other tests to determine exactly what the baby's condition is and how serious it is.
- Consultation: After that, the medical team will talk to you and your family about your options, what will happen if you have surgery, what will happen if you don't, and all the risks and benefits. This will help you make a decision.
- Preparation: If you decide to have surgery, you will make all the necessary preparations for it.
After surgery:
- Hospitalization: Depending on the nature of the surgery, you may need to stay in the hospital for a few days. Doctors and nurses will continue to care for you and your baby.
- Premature birth: Sometimes this surgery can cause the baby to be born before the due date (`preterm labor`). Doctors give medication to stop it, but it is not always successful.
- Cesarean section: If a fetal surgery is performed, the baby will inevitably have to be delivered by cesarean section (`C-section`) because there is an incision in the uterus.
- Special care for the baby: After birth, some babies may need treatment in the neonatal intensive care unit (NICU).
What are the benefits and risks?
Since this is a big decision, both sides need to be well understood.
The main benefit is that it can save the baby's life or significantly reduce the likelihood of future disabilities. Especially in conditions like `Spina Bifida`, early surgery increases the likelihood that the baby will be able to walk.
However, there are also risks . These can affect both the mother and the baby.
| Risks to the mother | Possible risks to the baby |
|---|---|
| Side effects caused by anesthesia. | Preterm labor. |
| Excessive bleeding during surgery. | Placental abruption. |
| Thinning or opening of the uterine cervix. | Infection of the amniotic fluid in the uterus (rare). |
| Current and future pregnancies may require cesarean section. | Chorioamniotic membrane separation. |
With a complicated pregnancy like this, the stress and anxiety can be overwhelming. Making decisions can be difficult for you and your family. You want the best outcome for both you and your baby. Your doctors want the same. So, don't be afraid to ask your doctor any questions you have. They will give you all the information you need and support you in making the decision.
Take-Home Message
- Fetal Surgery is a highly advanced surgical procedure that treats several very specific birth defects while the baby is still in the womb.
- This is done to save the baby's life or to minimize serious disabilities that may occur after birth.
- This is a very complex process, and there are significant risks for both mother and baby.
- Making this decision is a very sensitive and difficult thing. Discuss everything you have in mind, your fears, doubts, and questions, with your doctor.
- In such a situation, it is very important to seek advice from relevant specialists and a hospital that performs such surgeries.
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