Date: 24 October 2018
Surgery has been conducted in the womb for the first time in the UK, to repair the spines of two unborn babies with spina bifida.
The team supported by the NIHR Biomedical Research Centres at University College London Hospitals (UCLH) and Great Ormond Street Hospital (GOSH) have repaired spinal defects in two babies with open spina bifida, in separate operations this summer.
Spina bifida is a birth defect where the backbone and associated membranes fail to close fully around the spinal cord.
The current treatment in the UK for spina bifida is postnatal surgery after the baby is born. Babies with spina bifida are often not able to walk and may require a series of operations to drain fluid from the brain later in life (shunt placement).
In this new in utero technique, the pregnant woman undergoes a surgical procedure where the skin and womb are opened in the same place as for a caesarean section, although with a slightly wider cut. The spina bifida defect is examined and then surgically closed by a paediatric neurosurgeon in exactly the same way as a postnatal closure.
The 30-strong team involved in these first two operations was coordinated by fetal medicine consultant Anna David of UCL’s Institute for Women’s Health and UCLH.
Professor David, who is also supported by the NIHR UCLH Biomedical Research Centre, and her colleagues have been working for three years to bring this service to UK patients.
She said: “Our resolve to offer this service was based on the findings of a large, multicentre, randomised control trial in the US, which compared prenatal closure to postnatal closure. The US trial authors found that prenatal closure was associated with a 50% reduction in the need for surgical shunt placement in the newborn baby and a significant improvement in motor function at 30 months of age.”
Professor Paolo De Coppi, an NIHR Research Professor at the UCL Great Ormond Street Institute of Child Health and GOSH, added that the reduction in the need for shunts is a particularly important benefit of surgery in the womb.
“Long-term follow-up of children that have undergone prenatal closure in the womb suggests that brain function, mobility, and total independence were higher in non-shunted than shunted children aged 5,” he said.
You may also be interested in