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Birth of a Breakthrough: Spina Bifida Video - CHOP

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Considering Fetal Surgery for Spina Bifida

The Children’s Hospital of Philadelphia co-led a landmark clinical trial called the Management of Myelomeningocele Study (MOMS) to evaluate the effectiveness of prenatal fetal surgery for spina bifida as compared to traditional postnatal repair of spina bifida treatment. The nationwide, seven-year prospective, randomized study was performed in order to provide impartial, empirical evidence of the effectiveness of the fetal surgery for spina bifida versus postnatal repair of spina bifida. Study results showed that fetal surgery resulted in significantly reduced need for shunts to reduce fluid build-up in the brain, improved motor function, and increased likelihood of walking independently. This fetal surgery for spina bifida video discusses the factors that determine which patients are candidates for the surgery.

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The Birth of a Breakthrough Video explores spina bifida diagnosis, treatment options, delivery and follow-up care at The Children’s Hospital of Philadelphia. Experts at CHOP’s Center for Fetal Diagnosis and Treatment have the world’s greatest collective experience in prenatal repair for spina bifida.
 

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Transcript: Considering Fetal Surgery for Spina Bifida


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N. Scott Adzick, MD: For the first time in the history of mankind outside of postnatal repair of myelomeningocele, we have a new way to offer hope to the family and to the child with prenatally diagnosed spina bifida.

Leslie N. Sutton, MD: Early studies that we did suggested that fetal surgery might be beneficial, but to prove it, we had to do a randomized prospective clinical trial.

N. Scott Adzick, MD: The MOMS Trial started in 2003, and it was a head-to-head comparison between repair of myelomeningocele after birth to repair of myelomeningocele before birth.

Leslie N. Sutton, MD: And what the MOMS Trial has basically showed us is that the fetal surgery group has done significantly better in virtually every way compared to conventional treatment.

Mark P. Johnson, MD: It's very important that the family understands that fetal surgery is a really, really, really big deal.

N. Scott Adzick, MD: The mother has to go through an operation. She's an innocent bystander in all this. She has to undergo a big operation to potentially benefit her fetus.

Mark P. Johnson, MD: It's a complicated multidisciplinary surgery. There are significant risks of the surgery itself.

Leslie N. Sutton, MD: We have to tell them that they could lose the baby. We could do fetal surgery, and they could wake up not being pregnant.

N. Scott Adzick, MD: There's a risk that's substantial for the fetus, in terms of the risk of premature birth. For the mother, there is a risk of just general anesthesia and a big operation.

Martha G. Hudson, MSW: For some families fetal surgery is not going to be an option medically for the mother or the child.

Susan R. Miesnik, MSN: If the fetus does not have hindbrain herniation, for example, an Arnold Chiari malformation, that fetus would not be eligible. If the lesion, the defect, is really low in the spine in the sacral area, a lot of times we don't offer that surgery, also.

N. Scott Adzick, MD: Sometimes, with regard to fetal intervention, the patients are referred too late. So we will not do the fetal operation after 26 weeks gestation, for instance, because there appears to be no significant benefit.

Susan R. Miesnik, MSN: If the mother has certain medical conditions, it may exclude her from being offered this procedure – if the mother has severe diabetes or has severe asthma or has some issues with obesity or has mental health issues that are not well controlled. There are certain criteria that must be met. So the mother needs to be healthy in all aspects of her life.

Michael Mulligan, father: There are risks involved, but we knew that if they thought we were a good candidate, that it was potentially the right thing for us to do.

Katherine Mulligan, mother: A risk we were willing to take.

Michael Mulligan, father: Right.

Katherine Mulligan, mother: There is nothing more important than bringing that child into the world. And if we could get him here healthier, it meant the world to us.

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