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Birth of a Breakthrough: Spina Bifida Video - CHOP

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Another Choice: Postnatal Surgery for Spina Bifida

For some families, due to choice or health or other factors, postnatal surgery for spina bifida is the right option. In those cases, the mother and baby can be monitored at home and monthly ultrasound and pregnancy updates are monitored by CHOP. Mothers return to ChOP around 37 weeks gestation and delivery takes place by cesarean section. The baby is evaluated by the multidisciplinary team of experts and postnatal surgery for spina bifida is performed within 24-48 hours after birth. Mother and baby remain close to one another because the surgery suite is located in the same facility where the mother is recovering from birth. Generally, the mother can see and hold her baby on the same day as postnatal surgery for spina bifida. Both mom and baby undergo the same close monitoring as do patients following prenatal 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: Another Choice: Postnatal Surgery for Spina Bifida


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Mark P. Johnson, MD: It's important to understand that not all families want to have fetal surgery because of the requirements and the commitments and the risks that are involved.

Susan R. Miesnik, MSN: Families may come to us, undergo the diagnostic testing, and the defect may not be a defect that is included in the criteria for the surgery.

N. Scott Adzick, MD: Even if a family is an ideal surgery candidate, this may not be the best thing for them. And it is our obligation to help them understand that that's all right. That that's OK. That that's their choice. That that is the right choice for them.

Mark P. Johnson, MD: For families that want the traditional approach of having surgery after birth but still want to deliver at our center because of our multidisciplinary experience and care, we follow them as well. We, generally, have them come back at monthly intervals so we can monitor growth and development of baby – to look for their progression in the hydrocephaly and all the markers of complications. We, generally, deliver them at around 37 weeks.

N. Scott Adzick, MD: The mother, usually, has a cesarean section in the Special Delivery Unit.

Mark P. Johnson, MD: Our goal is to deliver the baby without any additional trauma to the myelomeningocele sac and also not to rupture the sac but to deliver the myelomeningocele intact. The baby then is evaluated by a neonatal resuscitation team.

Natalie E. Rintoul, MD: We have special equipment ready so that we can do different positions knowing that that spinal cord is still exposed.

Mark P. Johnson, MD: The baby then goes to the NICU where all the multiple subspecialties come and evaluate the baby. Neurosurgery, generally, take the baby to the operating room within the first 24 - 48 hours of life and do the neurosurgical repair.

Leslie N. Sutton, MD: The technical aspects are pretty much the same whether I do it prenatally or postnatally. I have the same layers. I do essentially the same operation. The beauty of our facility is that we have our own delivery suite right here in the Children's Hospital. So mother and baby are at the same place. So mother delivers. We get to look at the baby. We close the back the next day. I can talk to the mother about how things went, and she can hold the baby the next day.

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