Foetal surgery in Dubai corrects defect even before baby is born
Dubai doctors perform Arab world's first intrauterine foetal surgery
A 700-gramme baby got a defect corrected even before it was born as a Dubai hospital performed the Arab world’s first intrauterine foetal surgery.
The delicate six-hour surgery was performed on a 25-week-old foetus that was diagnosed with myelomeningocele — a type of Spina bifida (spinal cord defect) — at Latifa Hospital for Women and Children.
As the surgery was performed at this stage and not after the baby was born — which is typically still the standard medical procedure — the foetus’ defect was corrected, giving the baby a chance for improving cognitive function, lower limb function and deformities.
Spina bifida is a neural tube defect that occurs during the first month of pregnancy when the spinal cord does not develop or close properly. In its most severe form, the defect leaves a section of the spinal cord and nerves exposed in a sac on the patient’s back.
It can lead to many physical disabilities, including problems with walking and mobility, bowel and bladder function, wounds healing and fluid accumulating in the brain (hydrocephalus).
The mother and foetus have recovered in the intensive care unit (ICU) in the immediate post-operative period. They will be monitored until the day of the C-section. Post-delivery, the child will be followed up by a multidisciplinary team.
The Dubai Health Authority highlighted the medical breakthrough during a Press conference.
Dr Muna AbdulRazzaq Tahlak, consultant in Obstetrics and Gynaecology and CEO of Latifa Women and Children Hospital, said: “The patient was referred to us when she was 24 weeks pregnant after her condition was diagnosed in an ultrasound.
“Upon analysis, the patient underwent comprehensive counselling to understand the situation at hand, the medical options and to prepare her for the surgery.”
The 24-year-old Emirati patient, F.A., has two other children. She said she wanted to do everything possible for her baby’s wellbeing. “I want him to be a healthy boy and lead a healthy and happy life.”
How the surgery was performed
Dr Tahlak said a multidisciplinary team was present for the surgery.
“This kind of surgery requires extreme precision and is very delicate. It requires opening the uterus, but not the way it is done for C-Section. In this particular case, the incision was done from the back of the uterus. A minor incision was performed delicately — it had to be done in layers without opening the membrane that has the amniotic fluid and the foetus inside.
“We eventually opened the membrane. We then used certain tools to extend the incision as the baby had a 6-cm lesion in the spinal cord that needed to be fixed. We then gently positioned the baby in a way that the lesion was facing the incision so that Dr Mohammad Sultan Al Olama, the neurosurgeon, could correct the spinal cord defect. All through this time, the baby and the mother were being monitored with regular foetal heart rate monitoring.”
Dr Al Olama, who is consultant neurosurgeon with paediatric and functional neurosurgery specialty at Rashid Hospital, said he first gave the foetus anesthesia. “Then, under the microscope, I started to repair the defect. There was an extra sac that I removed and then preserved the spinal cord and the nerves. Then I covered it delicately using micro instruments with layers of different membranes sealed and then covered that by the skin so that amniotic fluid does not touch the foetus’ spinal cord. This step is essential to prevent leakage of spinal fluid.”
Once the neurosurgeon completed his part, the doctors filled the uterus with a special solution of antibiotics and saline. “I filled the fluid according to the amount of amniotic fluid lost during this procedure. We then closed the uterus again and tightly sealed it to prevent any leak of amniotic fluid. This procedure is also crucial as the uterus will expand in size as the foetus grows.”
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