Open fetal surgery for myelomeningocele (the most serious form of spina bifida) is a delicate procedure where fetal surgeons open the uterus and close the opening in the baby’s back while still in the womb. Watch this video with illustrations to learn about the detailed steps and teamwork involved in performing fetal surgery for spina bifida. While fetal surgery is not a cure for spina bifida, more than 20 years of testing and trial proved that operating on the baby in the womb can lead to significantly better results than traditional repair after birth.
Spina Bifida Surgery Before Birth: Illustrated Video
Narrator: Fetal surgery for spina bifida is an incredibly complex procedure. At Children's Hospital of Philadelphia, where the surgery was developed, a team of more than 20 people are in the operating room. They include up to four fetal surgeons, one neurosurgeon, two anesthesiologists, a maternal fetal medicine specialist, a fetal cardiologist and specialized nurses. They have performed this procedure more than any team in the world. Before surgery, the mother receives deep general anesthesia. Fetal surgeons make an incision across the mother’s abdomen. The maternal fetal medicine specialist uses ultrasound to determine the position of the fetus and the margins of the placenta.
The uterus is then opened with a specially designed uterine stapling device that controls bleeding, and the fetus is positioned so the spinal defect is visible. The fetal cardiologist monitors the baby's heart as the team closes the defect. The neurosurgeon removes a sac on the baby's back that covers the opening in the spinal cord. The sac is a thin membrane filled with fluid. The neurosurgeon and the fetal surgeon then close the defect in multiple layers using a lacing technique.
First the muscle layers are closed over the defect. Then the skin is closed over the muscle layers. This ensures a watertight closure. The mother's uterus is closed in multiple layers, then her abdomen is closed and she is returned to her room.
The pregnancy then continues until planned delivery at 37 weeks’ gestation, most often in our Special Delivery Unit created for moms carrying babies with birth defects.
Related Centers and Programs: Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment, Garbose Family Special Delivery Unit, Division of Neurosurgery