In a first for Africa, a baby has received spina bifida
surgery while in utero at the Mediclinic Morningside in Johannesburg. The
surgery was done by Prof Ermos Nicolaou, Specialist Obstetrician and
Gynaecologist, and Specialist in Maternal and Foetal Medicine at Morningside
and a team of international experts, led by Prof Mike Belfort from the United
States.

Prof Ermos Nicolaou says the foetus is at a gestational
age of 25 weeks. “Usually, in these cases parents can either choose to
terminate the pregnancy or to have the baby and undergo a series of surgeries
after delivery to repair the defect on the spine, the brain and the feet,” he
explains.

“In-utero surgery, like the one performed at Morningside,
will provide them with an additional option where a repair can be performed
before the baby is born.”

The procedure requires considerable expertise and involves a
team of experienced clinicians ranging from maternal and foetal medicine to
experts in neurosurgery, anaesthesiology, neonatology and specialised neonatal
ICU care. The operation also requires state-of-the-art surgical theatre
facilities.

Prof Nicolaou believes the repair of Spina Bifida in utero
may stop the inflammatory process that typically leads to damage of the nerves
and a range of potential abnormalities. The repair in utero, if successful, may
actually be the only surgery that is needed. The neurodevelopmental handicap
may be less severe and the overall prognosis may improve dramatically. As the
operation is performed through tiny instruments through the uterine wall and by
not cutting the uterus open, the recovery period is a lot faster and the
patient may go on to have a normal vaginal delivery if she wishes.

The aim of this particular surgery is to achieve a
successful operation with full recovery, minimal complications and no need to
perform further operations after the birth of the baby.

Prof Nicolaou cautions that one immediate risk is preterm
delivery of the baby. After the immediate postoperative period, close
monitoring of both the mother and foetus until delivery will be mandatory. Once
the baby is born, the neurosurgeon who was a member of the operating team will
assess the baby and decide if further corrective procedures will be required.

“The overall incidence of neural tube defects and spina
bifida specifically is around 1 per 1000 pregnancies,” he says. “We have
around a million live births in South Africa every year, so we are looking at
around 1000 new cases of neural tube defects every year. Our plan is to expand
our foetal surgery service to other abnormalities as well.”

Prof Nicolaou says he and his team aim to expand in-utero
surgery as a treatment for other abnormalities. Specialists and surgeons
would be able to offer surgery to correct defects in the heart, lungs, abdomen,
kidneys and bladder. These procedures would be performed only if the foetal
abnormality is so severe that it may lead to foetal death or severe handicap.

“Over the past fifteen years we have performed a number of
in utero procedures on foetuses at Mediclinic Morningside with great success,”
he says. “This is the next step in the evolution of foetal surgery in our
country.”

Source: Mediclinic