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Fetal surgery: what is it?
Advances in medicine are such that today it is possible to operate on a fetus in its mother’s womb. Still little known, fetal surgery is developing for a growing number of pathologies. Zoom in on these cutting-edge interventions.
It was in 2012 in Spain. Operated in utero at just 26 weeks due to a lung problem, little Alaitz was saved. Described as a world first, this operation had been around the world and highlighted this surgery still unknown to the general public. Born in the United States in the 80s, fetal surgery has had its ups and downs. Initially, fetuses were operated on like babies. Pediatricians intervened in the same way they could have done after birth. The consequences were dramatic. Extremely invasive for the fetus and for the mother, this procedure caused premature births and the loss of many babies. A new approach then developed. Based on the principle that it is always better to operate at birth, surgeons no longer treat the malformation as such, they try to prevent its consequences on the baby during intrauterine life. The goal is to act early enough to counteract the cascading effects in utero.
Fetal surgery, an alternative to IMG
When we offer intrauterine surgery, we are faced with abnormalities that are serious enough to lead to voluntary termination of pregnancy if the couple requests it. Most of the time, the malformation or disease is detected during the first ultrasound. But no question of intervening immediately. “It makes no sense to operate in the first trimester,” explains Prof. Yves Ville, head of the obstetric gynecology department at Necker Enfants Malades hospital and specialist in the field. The uterus must tolerate the surgery. Usually we wait until halfway through the pregnancy, ideally around 20 weeks. Parents are obviously the first concerned. “We spend a lot of time explaining to them the nature of the problem, why intervening before birth can avoid such and such a consequence, which we are able to do. But it is up to them to make the final decision, ”continues the specialist. The operation of a baby in utero is indeed a very delicate intervention. The risk of terminating the pregnancy is in the order of 10 to 15%. Like amniocentesis, these operations sometimes cause a rupture of the water bag and lead to a miscarriage.
Fetal surgery: focus on interventions
All indications combined, fetal surgery concerns around 1500 pregnancies per year. Very sharp, it allows to intervene on specific malformations.
The intrauterine operation is performed under local or epidural anesthesia. It is in principle performed endoscopically. Guided by the ultrasound, the surgeon introduces a trocar (large needle) into the mother’s womb, which contains both a telescope, an instrument or a laser fiber in order to be able to operate. Endoscopy allows live viewing on a screen the placenta and thus guide the surgical instruments. In general, the mother is hospitalized for 24 hours. She will need to rest for the next few days.