Pediatric Neurosurgeons Operate Before Birth to Improve Outcomes for Infants with Spina Bifida

November 30, 2017 | Crandall & Pera Law
Pediatric Neurosurgeons Operate Before Birth to Improve Outcomes for Infants with Spina Bifida

Spina bifida affects 1 in 1,000 births worldwide, and while the causes of the disease are not fully understood, there seems to be a link to a lack of prenatal folic acid. The severity of spina bifida varies from case to case, but it involves the tissue of the spinal cord failing to fully close, leading to issues with mobility, bladder and bowel issues, and hydrocephalus (fluid buildup in the brain). Surgeons have been exploring fetal surgery for spina bifida for over 20 years to reduce the severity of the defect, as spinal column exposure to amniotic fluid exacerbates the damage. The risk of early delivery as a result has always been present, but a new surgical technique, including the use of a fiber optic fetoscope, is making it possible to operate earlier, preserving more spinal cord functionality and leading to better outcomes for children and families. However, future risks remain for mothers who have undergone these procedures.

Surgery before birth

Beginning in the 1990s, medical professionals developed the open procedure, wherein the uterus is lifted out of the mother’s abdomen, cut, and then surgery is performed on the fetus, before it is returned to the uterus, which is then mechanically shut and returned to the mother’s abdomen. The new surgical procedure still involves removing the uterus from the mother’s abdomen; however, at that point instead of making one or more large cuts, a device called a fetoscope is used through one small incision and tools through a second small incision. These fewer, smaller wounds are less injurious to the uterus,  not unlike the way laparoscopic tools reduce recovery time for joint and other surgeries. Additionally, the use of a fetoscope allows mothers to carry their pregnancies closer to full-term than the former open procedure allowed. One other notable difference between the open and fetoscopic procedures is how the surgeons inflate and reflate the uterus. In the open version, amniotic fluid is saved and replaced at the end of the surgery. In the fetoscopic version, the amniotic fluid is drained, the uterus is inflated with carbon dioxide during the procedure to give doctors the best visualization of the spina bifida defect as they repair it, and then the uterus is refilled with saline solution. There is some concern that carbon dioxide could lead to neurological issues after delivery, but no consensus has been reached on the issue.

Risks to mother and infant

Any pre-birth surgery carries the danger of inducing labor; therefore, surgeons only perform the surgery on fetuses who have passed the point of viability, around 500 grams or 24 weeks gestational age. The perils of “uncomplicated” preterm birth for underage or underweight infants vary, but can lead to physical and mental disabilities, or even death. Birth injuries are also possible, due to the undeveloped musculoskeletal system of the infants involved. Threats are also present for mothers who undergo these procedures, regardless of the fetal outcome. Spina bifida pre-birth surgeries that involve fully cutting into the uterus can lead to uterine scarring, which in turn increases the incidence of cesarean section births for future pregnancies. When surgical errors occur, the outcomes can be dire for mothers and potentially impact their future fertility. At Crandall & Pera Law, our birth injury attorneys represent the interests of your family and your child, when he or she suffered harm during the birth process. If you are looking for compassionate, yet determined legal representation, please call our Ohio lawyers at 877-686-8879, our Kentucky lawyers at 877-686-8879, or use our contact form to make an appointment now.