Prenatal Surgery

Keyhole Surgeons Save Babies in the Womb

A PIONEERING new form of keyhole surgery will be used to save the lives of dozens of unborn babies every year, Scotland on Sunday can reveal.

The remarkable technique involves a ‘fetoscope’ about the width of three grains of sugar which is used to internally examine
babies while they are still in the womb.

The resulting images will allow Scottish doctors to perform surgical and other procedures on fetuses – many of whom would otherwise die – from as little as 24 weeks’ gestation.

At this point, the fetus would fit in the palm of an adult man’s hand and probably only just be opening its eyes.

Operations using the £70,000 fetoscope will be performed by a team of experts at Scotland’s national centre for diagnosing and treating pregnancy complications, the Department of Fetal Medicine at the Queen Mother’s Hospital, Yorkhill, Glasgow.

The development, which makes the Glasgow centre the only one outside London to carry out the procedures, has been hailed by birth charities as “amazing”.

One new procedure will correct abnormalities in the placenta that occur in twin pregnancies and result in one twin taking all the blood supply. Using the new scope and a laser, it will be possible to separate the blood vessels.

Dr Alan Cameron, a consultant in fetal medicine at the hospital, said: “We can diagnose and treat problems from a very early stage to late in pregnancy and we have been at the forefront of some tests and techniques.

“Fetoscopy is keyhole surgery using fibre optics to look at the baby directly. We have already bought the equipment to carry out the procedure and we are now hoping to get the service up and running.

“Currently mothers who need this procedure have to be sent to London.”

Around 60 sets of twins develop twin-to-twin transfusion syndrome in Scotland every year. Both usually die. But guided by the new fetoscope, doctors will destroy blood vessels in the placenta that the twins share, allowing at least one twin to survive.

Another complication in fetuses is caused by a diaphragmatic hernia, which occurs when the diaphragm develops a hole and the lungs fail to develop properly. There are around 20 cases of this condition in Scotland every year and it is also likely to prove fatal.

In the new procedure, doctors will use the fetoscope to guide them as they insert a tiny balloon into the foetus’s chest cavity, through its mouth, to allow the lungs to grow.

While mother and baby are sedated, doctors make an incision in the mother’s abdomen and insert the 3mm wide fetoscope, which is like a tiny telescope. It goes into the womb, into the baby’s mouth and down its throat.

Images are relayed on to a screen in a way that is similar to any other keyhole surgery. Doctors also use the incision to insert instruments to carry out the procedures.

The techniques themselves carry a risk of miscarriage but that is only 1-2% compared with a mortality rate of at least 80% for the conditions if left untreated.

Fetoscopy is not a new technique and, in its primitive form, was the only way of examining babies before it was abandoned around 30 years ago with the advent of ultrasound.

Subsequent advances in fibre optics and lightweight cameras mean the new fetoscopes can be used for detailed examination of potential problems flagged up using ultrasound.

Doctors at the Centre for Fetal Medicine already carry out a number of techniques to save babies’ lives using traditional ultrasound and 3D ultrasound technology to guide them.

Pregnant women from all over Scotland are referred to the centre. The team can diagnose conditions including cleft palate, heart and brain defects and problems with the gut.

The commonest procedures currently carried out at the hospital are blood transfusions on fetuses. In many cases these must be undertaken because the mother has the rare rhesus negative blood group which attacks the baby’s blood, resulting in heart failure.

Blood transfusions can also be given to babies if the mother contracts the infection parvovirus, which can cause anaemia in the unborn child.

Each year around 20 babies’ lives are saved with this procedure and the youngest baby to be treated was just 16 weeks gestation and 15cm long.

At this stage of pregnancy the baby is so small many mothers have yet to even feel it kicking.

The team can also place ‘shunts’ in the baby’s bladder or lung if it has developed abnormalities that prevent them draining fluid properly.

Each year in Scotland five babies develop these defects in the womb and their mothers have to be sent to London to have the surgery.

Last night Dorothy Maitland, spokeswoman for the Lothian Stillbirth and Neonatal Death Society, welcomed the development.

She said: “This is marvellous news for parents and shows just how advanced this technology has become.”

CASE STUDY
WHEN routine blood tests showed a problem with Kay Stembridge’s pregnancy she was referred to the Centre for Fetal Medicine in Glasgow.

She had developed a rare condition caused by her blood type, rhesus negative. Her blood had begun to develop antibodies to her baby’s blood, which could have led to a stillbirth.

She underwent three procedures to give her unborn baby blood transfusions. The amount of blood used in total was just 280ml but vital for her baby’s survival.

Euan was born in July 2004 by a planned Caesarean and transferred to intensive care. After several further blood transfusions he is now a healthy three-year-old boy leading a normal life.

Stembridge, a midwife from Edinburgh, said: “I was in shock when we discovered we had a problem with Euan. But the doctors at the centre were amazing. I can’t remember much about the procedure because I was sedated. It was a very worrying time for us.

“But it went well and when he was born he had more blood transfusions until all the antibodies from my blood were out of his system.”

This article: http://scotlandonsunday.scotsman.com/index.cfm?id=1883462007
Last updated: 02-Dec-07
[http://scotlandonsunday.scotsman.com/index.cfm?id=1883462007
KATE FOSTER ( [email protected]); Valko RN, 2Dec07]