By Natalie Homan from In The Cloud Copy
Spina bifida is a condition that appears when a developing baby’s neural tube doesn’t close completely. The most severe form of spina bifida, called myelomeningocele (my-uh-lo-muh-NING-go-seel) (MMC), results in a sac of fluid and nerves that pushes through the opening in the spinal column and bulges out the baby’s back. Often, the protruding nerves are damaged and the sac may even burst, leading to life-long complications for the child, including loss of feeling in the lower limbs, bowel problems, and build-up of fluid in the brain that must be drained with a shunt. For good reason, an ultrasound early in pregnancy that reveals MMC can cause great worry for parents.
Traditional Treatment
Traditionally, in cases where MMC is discovered during pregnancy, the baby has been operated on a day or two after birth. A neurosurgeon returns protruding nerves to the spinal column and repairs the damaged skin on the back. Even when done by the most expert surgeons, this surgery cannot repair damage that has already been done to the nerves, so the child will live with the complications common to spina bifida. They may also need further corrective surgeries in the future.
Prenatal Corrective MMC Surgery
In the last decade though, surgery before birth has become more common and has been shown to lead to improved outcomes for children.
Prenatal repair surgery is usually done between 23 and 26 weeks of pregnancy. The mother is put under general anesthesia, her abdomen and uterus are opened, and corrective surgery is done on the fetus. Once the surgery is complete, the nerves are no longer exposed to the amniotic fluid and so are protected from further damage throughout the remainder of the pregnancy.
Prenatal Surgery Leads to Improved Outcomes for Children
Studies done over the last decade on a group of children who had prenatal or postnatal corrective MMC surgery have shown that surgery during pregnancy results in better outcomes for the children.
In infancy and early childhood, children who had had prenatal surgery were more likely to walk independently and less likely to need shunts to drain fluid buildup in the brain. They also showed overall improved motor skills. The most recent study, published in January 2020, shows that these improvements continue into the children’s school years.
Factors to Consider
While these outcomes might make prenatal surgery seem like an easy choice, there are risks and complications that parents must consider. Some of these factors include:
- A more complicated remaining pregnancy for the mother, including an extended hospital stay while recovering from surgery and a few weeks of modified bedrest. Additionally, if the parents live far from a hospital where the surgery is offered, they may need to move closer to the hospital until the baby is delivered to allow for close monitoring after the surgery. This may be especially difficult for working mothers or mothers with other children in the home.
- Surgery during pregnancy increases the likelihood of preterm labor and, though uncommon, can carry a risk of fetal death.
Some mothers also may not qualify for prenatal surgery, including those with gestational diabetes, placenta previa, hypertension, or other health conditions that put them at risk during surgery. For those with health conditions or concerns about the feasibility of the prenatal surgery, the traditional surgery (done after birth) may be their best option.
Future of Prenatal MMC Repair
The future of treatment for babies with MMC is very positive. This continuing proof that prenatal surgery improves outcomes for children with MMC has led to increased studies on how to make the surgery better for mothers and babies. New methods for less invasive surgery are being tested that will hopefully allow the mother to recover better and lessen the risks for both her and her baby.
Check out the original study here.
