Video: Abu Dhabi doctors perform complex foetal surgery

Abu Dhabi: Doctors at an Abu Dhabi hospital recently performed a potentially life-changing in-utero procedure on a 24-week pregnant patient from South America.

The patient from Colombia underwent the rare open spina bifida foetal procedure at Burjeel Medical City’s Kypros Nicolaides Foetal Medicine and Therapy Centre in the hopes of preventing short-term and long-term complications for her baby, the hospital said.

Spina bifida is a birth defect that happens when the bones of the spine do not form and this leads to the spinal cord being left exposed to amniotic fluid, resulting in permanent disability. The condition can often lead to permanent loss of bowel and urinary bladder control, paralysis or weakness of both lower limb muscles.

In-utero repair

The in-utero repair is performed between 19-25 weeks of gestation to close the defect in the spine, thereby offering improved outcomes. The average worldwide incidence of spina bifida is one per 1,000 births.

A team of doctors at Burjeel Medical City performed the procedure last week. The multidisciplinary team led by Dr. Mandeep Singh, consultant, Foetal Medicine and Obstetrics, and CEO of Burjeel Farha (a division of women and children) at Burjeel Medical City and visiting physician Dr. Mauricio Herrera, also included Dr. Rajasekhar Cingapagu, specialist, Pediatric Surgery, Dr. Essam Elgamal, consultant, Neurosurgery, Dr. Ramamurthy Baskaran, consultant Anesthesiology & Transplant Anesthesia, Dr. Ahmed Omran, consultant Anesthesia, and Dr. Iviano Ossuetta, consultant and director of Neonatology as well as specially trained operation theatre staff.

Baby will remain in the womb

During the foetal repair surgery, a small incision is made on the uterus and the back of the baby is exposed to allow the neurosurgeon to close the spina bifida defect, said Dr. Singh who has trained and worked in the UK for 22 years.

“We use a synthetic patch to cover the defect. The amniotic fluid is then instilled back into the cavity and the uterus is closed back up. The baby will remain in the womb for the remainder of the pregnancy and will be delivered by caesarean section at 37 weeks’ gestation,” the doctor said.

The mother is stable and expected to deliver her baby at the same hospital in August. After the birth, a specialist team of neonatologists, pediatric urologists, and a pediatric orthopedic, and rehabilitation team will review the baby and plan its care.

“We were shocked after our routine 20-week scan showed that our baby’s spinal cord was not forming correctly. The options of ending pregnancy were also discussed with us but we believe in miracles and that life is a gift of God. Our doctor suggested that our best course of action was to undergo spina bifida repair before the baby was born,” said Liz Valentina Parra Rodriguez and Jason Mateo Moreno Gutierrez, the Colombian couple who travelled to Abu Dhabi for the procedure to give their baby the best chance possible.

Advanced foetal care

According to Dr. Singh, the procedure is not a cure, but it could make a big difference in the child’s life after birth. “In-utero repair of spina bifida reduces motor function loss of limbs and improves outcomes. After the delivery, the baby needs follow up and, in some cases, may need to undergo physiotherapy and all other medical assessments to ensure their well-being,” Dr. Singh said.

If untreated, depending on the severity of the condition, a baby born with spina bifida is at risk of developing a host of complications ranging from orthopedic problems to issues with bowel and bladder control.

Despite its risks, early intervention through foetal surgery is said to improve outcomes in babies. According to a large randomised controlled trial on Management of Myelomeningocele Study (MOMS), foetal surgery for spina bifida reduced the need for ventriculo peritoneal (VP) shunt – a procedure to put a tube from the brain to the abdomen to drain all the fluid and prevent damage to the brain – once the baby is born. If the corrective surgery is performed after birth, it could increase the risk of hydrocephalus, where too much fluid builds up in the brain and can exacerbate nerve damage due to changes in the amniotic fluid during pregnancy.

High-risk proceedure

The Kypros Nicolaides Foetal Medicine and Therapy Centre at Burjeel Medical City said it is well-equipped to perform such high-risk maternity and delivery care seamlessly. Laser separation of placenta for twin-to-twin transfusion syndrome, foetal endotracheal occlusion for congenital diaphragmatic hernia, foetal blood transfusion, shunts and management of foetal tumors are some of the other procedures that can be performed at the foetal therapy centre. The complex care units at the hospital support the centre by providing other medical services to help patients recover after birth, it said.

It is important that foetal surgeons and centres performing complex in utero surgeries undergo appropriate training and continue to perform such procedures regularly to ensure good outcomes. Kypros Nicolaides Foetal Medicine and Therapy Centre has a vast network of foetal medicine centers across Asia, Africa and South America to collaborate with and perform such procedures regularly.

“The long-term rehabilitation, neurosurgery, orthopedics, and other complex care offerings at Burjeel Medical City are capable of providing timely support to the babies and families across the region,” Dr. Singh said.