Fetal surgery
Fetal surgery in nagpur is also termed as intrauterine surgery. It is a highly specialized or complicated medical intervention on the fetus who is still inside the uterus. The theoretical considerations of fetal surgery in nagpur include:-
1. Indications:- Potentially life-threatening congenital anomalies
2. Types of procedures:- Open fetal surgery
3. Anatomical considerations: – Fetal size or position
4. Surgical techniques:- Hysterotomy (incision in the uterus)
5. Anesthesia and pain management:- Maternal and fetal anesthesia
6. Fetal monitoring and surveillance:- Intraoperative monitoring
7. Maternal concerns:- Preoperative preparation
8. Ethical and legal concerns:- Informed consent
9. Fetal development and physiology:- Fetal growth and maturation
10. Postnatal care and follow-up:- Neonatal intensive care
Theoretical knowledge about fetal surgery is imperative for healthcare professionals who are made aware of the complications and shades of this highly specialized field, wherein best care for both mother and fetus would be provided.
Fetal surgery is surgery conducted within the womb, directly on the fetus. The aim of such surgical intervention in medical field is to treat life-threatening anomalies or congenital conditions that are threatening the fetus’s life and well-being by posing a high risk.
Types of fetal surgery:
1. Open fetal surgery: In this process, an incision is created both inside the abdomen and womb of the mother to open up an access route to the fetus.
2. Minimally invasive fetal surgery: This includes a small incision and then insertion of instruments through trocars or endoscopes.
3. Fetal endoscopy: This involves the insertion of very thin flexible scopes through a small incision to see and manage the fetus.
Conditions treated with fetal surgery:
1. Neural tube defects (spina bifida, anencephaly)
2. Congenital diaphragmatic hernia
3. Twin-to-twin transfusion syndrome
4. Fetal heart defects
5. Fetal lung lesions
6. Sacrococcygeal teratoma
7. Congenital cystic adenomatoid malformation
Fetal surgery is very risky and a procedure that really calls for a multidisciplinary team of specialists, who are specialized at:
1. Maternal-fetal medicine specialists
2. Pediatric surgeons
3. Fetal cardiologists
4. Neonatologists
5. Anesthesiologists
The risks and benefits need to be weighed and informed consent needs to be sought. Fetal surgery may be a resort to an optimizing outcome even at the cost of saving life, but it is always associated with the dangers posed both to the mother and the fetus as well.
What Is a Fetal surgery?
Fetal surgery, otherwise known as a intrauterine surgery, refers to the medical operation performed on a fetus in the utero. Fetal surgery is an extremely specialized, highly complex surgical intervention for potentially life-threatening congenital anomalies or conditions otherwise strongly threatening the life of the fetus or significantly threatening well-being.
Fetal surgery interventions include:
1. Direct surgical anomaly repair
2. Intrauterine procedures aimed at improving fetal well-being
3. Treatment of potentially life-threatening conditions
The aims of fetal surgery are as follows:
To ensure the survival of the fetus
Enhance the well-being of the fetus
Reduce the potential complications
Better postnatal outcome
Fetal surgery is usually undertaken between 18 and 30 weeks of gestation based on the condition. A team of multidisciplinary specialists, including maternal-fetal medicine specialists, pediatric surgeons, fetal cardiologists, neonatologists, and anesthesiologists, is involved in the procedure.
Fetal surgery is one of the tremendous advances in medicine and brings hope to families diagnosed with severe congenital anomalies, improving the chances of a healthy outcome for mothers and their babies.
Types of Fetal Surgery
- Open Fetal Surgery:
- This is a highly invasive procedure where the mother’s abdomen and uterus are surgically opened to access the fetus for treatment. It is similar to a cesarean section but is done before the baby is full-term. After the procedure, the fetus is returned to the womb, and the pregnancy continues until delivery.
- Common Indications:
- Spina Bifida (Myelomeningocele): A neural tube defect where the spine and spinal cord do not develop properly. Surgery can help reduce neurological damage.
- Congenital Diaphragmatic Hernia (CDH): A condition where the diaphragm does not form correctly, allowing abdominal organs to enter the chest and compress the lungs. Surgery can reposition the organs and help the lungs develop.
- Minimally Invasive Fetal Surgery (Fetoscopy):
- In this technique, small incisions are made in the mother’s abdomen, and a thin tube with a camera (fetoscope) and surgical instruments are inserted into the uterus. This allows surgeons to perform procedures without fully opening the uterus.
- Common Indications:
- Twin-to-Twin Transfusion Syndrome (TTTS): A condition in identical twins sharing a placenta, where blood flow is unevenly distributed between the twins. Laser therapy can be used to seal off shared blood vessels.
- Fetal Bladder Obstruction (Lower Urinary Tract Obstruction): Insertion of a shunt to drain excess fluid from the fetal bladder, preventing kidney damage.
- In-Utero Shunt Placement:
- This procedure involves placing a small tube (shunt) to drain excess fluid from certain fetal organs or cavities, such as the chest or bladder. It helps relieve pressure and allow proper development of other organs.
- Common Indications:
- Fetal Hydrothorax: Fluid buildup in the chest cavity that can compress the lungs.
- Hydronephrosis: A blockage in the urinary tract causing urine to build up in the kidneys, which can be drained using a shunt.
- Ex Utero Intrapartum Treatment (EXIT) Procedure:
- A specialized procedure performed at the time of delivery, where the fetus remains partially attached to the placenta while surgery is performed to secure the airway or treat certain life-threatening conditions.
- Common Indications:
- Airway Obstruction: If the fetus has a condition like a neck mass or tracheal obstruction that could block breathing after birth, the EXIT procedure allows for the airway to be secured while the baby still receives oxygen from the placenta.
Risks of Fetal Surgery
Fetal surgery is complex and carries significant risks for both the mother and the fetus. These risks may include:
- Preterm Labor: One of the most common risks following fetal surgery is early onset of labor, leading to premature birth.
- Infection: Opening the uterus increases the risk of infection, which could affect both the mother and fetus.
- Uterine Rupture: In open fetal surgery, there is a risk of uterine rupture in future pregnancies due to the uterine incision.
- Fetal Death: There is always a risk that the fetus may not survive the surgery or may develop complications afterward.
- Complications for the Mother: Mothers may face complications from anesthesia, bleeding, or infection.
Benefits of Fetal Surgery
When successful, fetal surgery can significantly improve the outcomes for babies born with certain congenital conditions. The benefits include:
- Improved Neurological Outcomes: For conditions like spina bifida, early surgical correction can prevent further damage to the spinal cord and improve mobility and function.
- Better Lung Development: In cases like congenital diaphragmatic hernia, repositioning organs can allow for proper lung growth.
- Increased Survival Rates: For conditions like twin-to-twin transfusion syndrome, fetal surgery can improve the survival rates of both twins.
Post-Surgical Care and Delivery
After fetal surgery, pregnancies are closely monitored to ensure that both the mother and fetus remain healthy. In many cases, the baby may be delivered early due to the increased risk of preterm labor.
- Delivery Planning: Most women who undergo fetal surgery deliver via cesarean section, especially if the surgery involved an open approach.
- Neonatal Care: Babies who have undergone fetal surgery often require specialized neonatal care after birth. In some cases, additional surgeries may be needed after delivery to correct or finalize the repair of the condition.
Conditions Treated by Fetal Surgery
Fetal surgery may be indicated for a range of conditions that could severely affect fetal development or survival, including:
- Spina Bifida: A neural tube defect leading to exposed spinal cord.
- Congenital Diaphragmatic Hernia (CDH): A defect in the diaphragm affecting lung development.
- Twin-to-Twin Transfusion Syndrome (TTTS): Unequal blood flow in twins sharing a placenta.
- Fetal Tumors: Such as sacrococcygeal teratoma, a tumor located at the base of the fetus’s spine.
- Lower Urinary Tract Obstruction: A blockage in the fetal urinary tract leading to kidney damage.
- Congenital Heart Defects: Certain heart defects may be repaired in utero, though this is still an evolving field.
At our Neurosys Multispeciality Center, we perform several key procedures including Craniotomy, which is primarily for the excision of brain tumors; V-P Shunt Surgery for treating hydrocephalus; surgeries for epilepsy; and operations targeting brain stem glioma. Beyond these, we offer a range of other neurosurgical services. If you have any questions that are not answere, please contact us through our Contact Us or Book your Appointment.