Advancements in fetal interventions enable treatment of some medical conditions before your baby is even born.
By the Texas Children’s Fetal Center team
When a couple learns they’re expecting a new baby, it can be one of life’s most joyous occasions. Some parents, however, learn during pregnancy that their child has a potentially life-threatening anomaly that may cause long-term health consequences after birth and beyond.
Thanks to advances in fetal medicine there are now therapies not previously available to patients with conditions such as congenital diaphragmatic hernias (CDH), spina bifida and previously fatal heart diseases. Many of these conditions can now be treated with surgery in-utero while a baby is still growing and developing.
Among the many innovative procedures, is fetal endotracheal occlusion (FETO) procedure for CDH, a condition that occurs in approximately one in 2,500 to 5,000 babies. This defect, which is a hole in the diaphragm, can allow the intestines and other organs in the abdomen to enter the chest cavity where they press against the lungs and limit their development and growth. It can also cause blood vessel abnormalities and pulmonary hypertension. Babies born with CDH usually have breathing problems and they may experience improper development of other organs, including the heart, brain, kidneys and intestines. If CDH is severe, the FETO procedure, a surgical technique Texas Children’s helped pioneer, may be an option.
Spina bifida is an open neural tube defect (NTD) in which the bone and skin that surround the spinal cord at the back do not form properly. One of the most common birth defects, spina bifida can cause abnormalities in the function of the bladder, bowels and legs and babies may also develop hydrocephalus or excess “water on the brain.” Studies show that repairing a NTD prior to birth can improve outcomes for babies. In addition to offering an open spina bifida repair surgery while baby is in-utero, surgeons at Texas Children’s have also pioneered an experimental fetoscopic surgery for NTD repair which reduces the chance of uterine rupture and may allow for a vaginal delivery in patients who are good candidates.
Another area of innovation is cardiac fetal intervention, including fetal aortic balloon valvuloplasty to treat critical aortic valve stenosis. In this procedure, a needle is inserted through the mother’s abdomen into the womb using ultrasound images to guide the needle. An anesthetic is given to the baby prior to advancing a needle through his/her chest wall into the heart. A wire is then inserted through the needle across the aortic valve and a thin tube (catheter) with a special balloon is then inserted and the balloon is inflated to expand the narrowed valve so blood can flow through it more easily. The tube and needle are then removed.
Receiving news that your unborn child has a fetal anomaly is terrifying, but there are innovative fetal interventions that can help improve your baby’s outcome. It is imperative that all mothers-to-be receive the recommended prenatal care as early detection of fetal anomalies is critical.