The development of open surgical procedures has been dependant on the development of a technique of opening and closing the uterus without causing premature labour. This has now been largely achieved although significant maternal risks remain.
The conditions for which in utero fetal surgery is appropriate may include those which cause progressive fetal damage if left untreated until the neonatal period. Two disorders for which these criteria may apply include diaphragmatic hernia and urinary tract obstruction although even spina bifida may be included in the future.
- Diaphragmatic Hernia
- Urinary Tract Obstruction
- Spina Bifida
Diaphragmatic Hernia
Congenital diaphragmatic hernia with fetal liver in the fetal chest has an extremely poor prognosis as it is almost invariably complicated by pulmonary hypoplasia. In these cases it has been demonstrated that if the hernia can be slowly reduced in utero by progressive lung expansion secondary to blocking the trachea, allowing normal lung development to occur.
A technique has subsequently been developed which allows the trachea to be blocked in-utero with a clip which can be removed at delivery and allows normal lung development to occur. The hernia can then be formally repaired immediately after birth.
Although this technique is still experimental, preliminary results are encouraging
Urinary Tract Obstruction
Although an open surgical procedure was initially developed for this disorder because of the problems of subsequent premature delivery this has been largely replaced with the cystoscopic procedure described above.
Spina Bifida
The neurological damage seen in spina bifida appears to be due to the exposure of the spinal cord to amniotic fluid and it has been shown in animal experiments that if an artificially created neural tube defect is repaired with a covering of skin, the extent of the damage can be reduced. It may be possible to repair naturally occurring defects in-utero. Surgical techniques are currently being developed overseas.