Spina Bifida Surgery During Pregnancy: Illustrations

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Fetal surgery for myelomeningocele, the most serious form of spina bifida, is an incredibly complex procedure. The team at Children’s Hospital of Philadelphia has performed this procedure more times than anyone in the world. See step-by-step illustrations of each stage in the delicate surgery.

Spina Bifida Surgery During Pregnancy

  • Illustration of mother's whole body and fetus
    Before undergoing fetal surgery for myelomeningocele (MMC), the mother will receive deep general anesthesia, which also anesthetizes the fetus.
  • Illustration of mother with uterus incision before fetal surgery for MMC
    Fetal surgeons make an incision across the mother’s abdomen.
  • Illustration explaining how ultrasound determines the location of the fetus before fetal surgery for MMC
    The maternal-fetal medicine specialist uses ultrasound to determine the location of the fetus.
  • Illustration of a fetus with exposed fluid filled sac in preparation for fetal surgery.
    The uterus is then opened with a specially designed device that controls bleeding, and the fetus is positioned so the defect is visible. Usually, the exposed spinal cord and nerves are contained in a sac. The sac is a thin membrane filled with fluid.
  • Illustration of fetal surgery for MMC step when neurosurgeon removes the sac on the baby’s back.
    The pediatric neurosurgeon removes the sac on the baby’s back that covers the opening in the spinal cord.
  • Illustration of fetal surgery for MMC when defect is closed in multiple layers
    The neurosurgeon and the fetal surgeon then close the defect in multiple layers, using a lacing technique.
  • Illustration of muscle layers being closed over open MMC defect
    First, the muscle layers are closed over the defect.
  • Illustration skin being closed over muscle layers in fetal MMC surgery
    Then, the skin is closed over the muscle layers. This technique ensures a watertight closure.
  • Illustration of uterus closure in MMC fetal surgery
    The mother’s uterus is closed in multiple layers.
  • Illustration of abdomen closure after fetal surgery for MMC
    The abdomen is then closed and the mother is stabilized and returned to her room. The pregnancy then continues until planned delivery at 37 weeks gestation, most often in our Garbose Family Special Delivery Unit, created specifically for healthy mothers carrying babies with birth defects.
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Learn more about spina bifida.