Benefits of prenatal repair
Families want to understand the benefits of prenatal repair.
The MOMS Trial helped answer that question as well. While there is no cure for spina bifida, repairing the spine in the womb can minimize the spinal defect.
Prenatal surgery also lowers the risk for a shunt. For babies that have surgery after birth, 82 percent will require a shunt to be placed in the brain. This is due to the formation of water on the brain or hydrocephalus. The shunt drains the fluid from the baby’s brain to the intestines.
Because a shunt is a piece of hardware, it can clog, get infected or break, and a typical child may have one or two shunt repairs before they’re an adult.
For babies that undergo prenatal repair, only 40 percent would need a shunt placement in their first year of life.
Reducing the need for a shunt improves the spinal cord function. The MOMS Trial showed babies that underwent prenatal repair had more mobility, move movement in the legs and better neurologic outcomes.
Another benefit to closing the spina bifida prenatally is the child is healed and sealed at birth. The mother can bond, hold and nurse her child without worrying about a fresh incision she can’t put pressure on. Or worst case, the mother has to worry about the incision getting infected.
Risks that must be considered
Risks to both the baby and the mother must be considered.
Risks to the baby
The baby’s risks are centered on premature delivery. The fetal MMC repair has an average delivery at 33 – 34 weeks. Babies who have repair after birth are born at 38 weeks on average. The delivery of fetal MMC babies before 30 weeks decreases the chances of the benefits from the surgery during pregnancy.
Mothers who choose the fetal MMC repair will experience the bag of water breaking before delivery almost half the time. If the bag of water breaks, the mother must be admitted to the hospital. Importantly, if the water breaks, not all women have to be delivered. Most often, at less than 34 weeks pregnancy, if the mother and fetus are stable, the pregnancy will continue.
About 4 out of 10 women will have preterm labor. When or if this occurs, she must seek medical care and most often be admitted to the hospital. Again, the incision on the mother’s uterus should not have labor pressures. Although rare, the incision could open – referred to as uterine rupture. This rare moment is an emergency for both mother and baby in the womb.
Risks to the mom
The mothers’ risks are those of premature labor, the bag of water breaking and the possibility of the uterus’ incision opening with labor which may have emergency surgery, bleeding and infection risks. The mothers’ risks most often have her admitted to the hospital.
Fetoscopic repair is another method being performed at centers in the United States and Europe. A fetoscopic method is where providers repair the baby’s MMC while in the uterus using a small fiberoptic camera and thin, small instruments. This minimizes the risks to the mother because an incision (opening the uterus) is not required. Without an incision on the uterus, the woman can labor (if appropriate) when the time of delivery occurs.
At this time, it is uncertain if this type of fetal MMC repair has the same benefits found from the present operation with the incision on the uterus.