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Fetal Surgery for Spina Bifida

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Published on Apr 26, 2019

Fetal surgeons at Children’s Hospital of Philadelphia are experts in prenatal diagnosis and fetal surgery for spina bifida. https://www.chop.edu/fetalsurgerymmc

1:36 What is spina bifida?
1:59 Why is your spinal cord important?
2:24 Treatment options after a prenatal spina bifida diagnosis
2:54 Long-term issues for children with spina bifida
3:06 Shunt for hydrocephalus (water on the brain)
3:27 What is hindbrain herniation?
5:07 Explaining fetal surgery for spina bifida
6:18 Between fetal surgery and delivery
8:22 After delivery of a baby with spina bifida
8:54 Support for families

Spina bifida is a birth defect in which an area of the spinal column doesn’t form properly, leaving a section of the spinal cord and spinal nerves exposed through an opening in the back. It is the most common birth defect of the central nervous system, affecting about 1,500 babies born each year in the United States. The two main spina bifida treatment options are fetal surgery during pregnancy or surgery on the baby right after birth.

Mothers carrying babies diagnosed with spina bifida need to know they are getting the most accurate information from an experienced, caring team. Since 1995, Children’s Hospital of Philadelphia’s (CHOP) Center for Fetal Diagnosis and Treatment has been at the forefront of understanding, diagnosing and treating myelomeningocele (MMC), the most severe form of spina bifida, before birth.

In this video, surgeons and others explain spina bifida treatment options, the benefits of spina bifida surgery before birth, the team required to perform this complex procedure, and the support services Children’s Hospital of Philadelphia offers families. The video also shares spina bifida fetal surgery stories from the perspective of families.

Open fetal surgery for myelomeningocele is a delicate procedure where fetal surgeons open the uterus and close the opening in the baby’s back while still in the womb. The procedure was pioneered by N. Scott Adzick, MD, MMM, and the team at the Center for Fetal Diagnosis and Treatment. The team has performed more than 350 fetal surgeries on babies with MMC, maintaining optimal patient safety and following high standards for prenatal myelomeningocele repair to ensure the best possible outcomes for mother and baby.

Expectant mothers from all 50 states — and more than 60 countries — have traveled to Philadelphia for care at the center.

The video features Gregory Heuer, MD, PhD, pediatric neurosurgeon, Julie S. Moldenhauer, MD, medical director of the Garbose Family Special Delivery Unit, Lori J. Howell, DNP, MS, RN, executive director of the Center for Fetal Diagnosis and Treatment, Sue Spinner, MSN, RN, clinical coordinator, and N. Scott Adzick, MD, MMM, founder and Director of the Center for Fetal Diagnosis and Treatment and Surgeon-in-Chief of Children’s Hospital of Philadelphia.

While fetal surgery is not a cure for spina bifida, more than 20 years of testing and trial proved that operating on the baby in the womb can lead to significantly better results than traditional repair after birth. Because spinal cord damage is progressive during gestation, prenatal repair of myelomeningocele may prevent further damage.

In 2011, center experts co-led the Management of Myelomeningocele Study (MOMS), a landmark nationwide controlled clinical trial that confirmed that fetal surgery for spina bifida greatly reduces the effects of hindbrain herniation, reduces the need to divert fluid from the brain, improves mobility and improves the chances that a child will be able to walk independently. These results, published in the New England Journal of Medicine, conclusively established the effectiveness of fetal surgery for spina bifida.

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