UAE: Fetus undergoes surgery in the womb, born after two months

A healthy fetus underwent surgery for a spinal defect when it was inside her mother’s womb. The surgery was carried out when the mother was at 24 weeks pregnant, and entered this world after two months.

The fetus of Liz Valentina Parra Rodriguez was suffering from open Spina Bifida, which is a birth defect that happens when the bones of the spine do not form, and this leads to the spinal cord being left exposed to amniotic fluid. The condition can lead to serious neurological complications and physical disabilities.

The surgery to address open Spina Bifida repair in utero was carried out by a team of surgeons at Burjeel Medical City which marked an important milestone in the field of fetal medicine in the UAE. Post the surgery, the doctors said that both fetus and her mother were in good health.

The procedure was carried out in June, led by Dr Mandeep Singh, consultant, Fetal Medicine and Obstetrics, director of Kypros Nicolaides Fetal Medicine & Therapy Center at Burjeel Medical City, who also monitored the progress of both the baby and the mother during the two months following the surgery.

During the fetal repair surgery, the doctors made a small incision on the uterus and the back of the unborn baby was exposed to allow the neurosurgeon to close the spina bifida defect. The doctors used a synthetic patch to cover the defect and the amniotic fluid was then instilled back into the cavity and the uterus was closed and the baby remained in the womb for the remainder of the pregnancy.

Rodriguez delivered a baby girl and named her Maryam Violeta. The delivery was conducted by Dr Ritu Nambiar, consultant, obstetrician and gynecologist after Rodriguez went into spontaneous labor at 35 +4 weeks. The baby, who weighed 2.46kg at birth, had a small gap in the skin over the back, which was closed by Dr Essam Elgamal, consultant neurosurgeon.

Maryam was under the care of a neonatal medical team led by Dr Iviano Rudolph Ossuetta, consultant, director of neonatology.

Although it is too early to comment about the extent of recovery, the medical team is cautiously optimistic about her future. According to them, the urinary bladder is functioning well and both legs have normal tone and movements.

“The spina bifida repair was intact and hence the in-utero procedure is deemed successful. Maryam is displaying positive signs of recovery. Although it's still early to predict the full extent of her recovery, the initial indicators are promising. Ultrasound and MRI of the brain are normal and hence there is no indication for performing VP shunt, which is a very distinct advantage of performing the repair in utero and is often used to manage excess cerebrospinal fluid buildup in the brain, which can be a common complication in Spina Bifida cases,” said Dr Mandeep.

A ventriculoperitoneal (VP) shunt is a cerebral shunt that drains excess cerebrospinal fluid (CSF) when there is an obstruction in the normal outflow or there is a decreased absorption of the fluid.

“We are already in touch with a team of doctors at our partner organisation Colsanitas Clinic, Colombia, and will hand over the care of baby Maryam once she returns home to Bogota, Colombia. She will need to undergo follow-ups with a pediatric urologist, pediatric neurologist, and physiotherapist,” the doctor added.

Rodriguez and her husband Jason Mateo Moreno Gutierrez are getting ready to return to their home country of Colombia in two weeks along with their newly born daughter.

“Our princess Maryam is the best present that we could have ever gotten. God has blessed us with the perfect gift. We are extremely grateful to the hospital and the team for taking care of us and helping us during this difficult time. We fully understand that Maryam will need medical attention for the next few years, but we will do whatever we can to support her. We are very thankful to everyone for blessing our daughter,” said Rodriguez.

The average worldwide incidence of Spina Bifida is one per 1,000 births.

The in-utero Spina Bifida procedure was performed by a multidisciplinary team led by Dr Mandeep and visiting physician Dr Mauricio Herrera in June this year. The team also included Dr Rajasekhar Cingapagu, specialist pediatric surgery, Dr Essam Elgamal, consultant neurosurgery, Dr Ramamurthy Baskaran, consultant anesthesiology and transplant anesthesia, Dr Ahmed Omran, consultant anesthesia, and Dr Iviano Ossuetta, consultant and director of Neonatology and specially trained operation theatre staff.

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