Prenatal Surgery

Surgery for the Unborn Proves Impressively Successful

Babies with a severe congenital spinal cord defect (called a “myelomeningocoele”) are at high risk of developing permanent brain and spinal cord damage, if the defect is not repaired soon after birth.

Recently a consortium of world-renowned pediatric hospital centers have investigated whether performing surgery on a baby, while he or she is still in the womb, would be safe.

These surgeons found that prenatal surgery (surgery while the baby is still in the womb) is not only as safe as waiting until right after birth, but it actually results in better outcomes.

Babies with myelomeningocoeles often need to have ‘shunts’ placed, in order to release pressurized water which is accumulating around their brain (hydrocephalus). Those babies, who had undergone surgery before they were born, later needed to have a shunt placed less often.

Three years later (30 months after surgery), the babies who had undergone surgery in the womb were functioning at a higher level, with better motor skills and less need for leg braces, than were those babies whose surgery had been delayed until after they were born.

And this improvement occurred despite the fact that the babies who underwent surgery before they were born happened to have, on the whole, more serious spinal defects than those who had their surgery after they were born.

These improved results, from performing surgery before birth, were so striking that the investigators stopped the study early, in order to share the good news.

This surgery is very serious, whether performed before or after birth. Two babies died in each group. Babies who underwent surgery in the womb were at higher risk of premature birth, and their mothers were at higher risk of injury to the womb.

Doctor Carl Olsson, a prestigious urologist at Columbia University, notes, “We have probably entered a new era in myelomeningocoele management with this study.”[1]

This study was performed by the Myelomeningocoele Study (MOMS) Group – at Children’s Hospital of Philadelphia, Vanderbilt University and University of California, San Francisco. It was reported in the 17 March 2011 edition of the New England Journal of Medicine.[2]

[1] Olsson C: “Have You Read?” AUA News, (May)2011; 16(5): 24-25.

[2] Adzick NS, Thorn EA, Spong CY, et al: Randomized trial of prenatal versus postnatal repair of myelomeningocele. New England Journal of Medicine, (March 17) 2011; 364 (11): 993-1004.

Note: This operation requires extraordinary surgical skill and may only be available at select regional centers.

The good news is that, in many cases, myelomeningocoele can be prevented, when women adopt healthy eating habits, during and even before pregnancy – with diets that include good amounts of folic acid (for instance, in orange juice, leafy green vegetables and whole grain foods fortified with vitamin B complex).

Avoiding excessive weight also seems to reduce the risk.
Women planning for pregnancy need to remember that they should begin eating for two — wisely and well — even before conception.

Instead of aborting, let’s repair!!

[1 Sept 2011]