Fetal surgery
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216822861
2008-06-03T11:35:47Z
Damuna
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/* Overview */
Open '''fetal surgery''' is an invasive form of [[fetal intervention]] in the treatment of [[birth defect]]s where the pregnant [[uterus]] is opened up for direct surgery on the [[fetus]].
{{Infobox Person
| name = open fetal surgery
| image = Samuel Armas Aug19 1999.jpg
| image_size = 200px
| caption = [[Samuel Armas]]'s arm slipping out of the [[uterus]] of his mother, Julie Armas. Doctor's hands are Dr. Joseph Bruner. Photographed by [http://www.michaelclancy.com/index.html Michael Clancy] during [[fetal surgery|open fetal surgery]] for [[spina bifida]].
}}
== Overview ==
Open fetal surgery is similar in many respects to a normal [[cesarean section]] performed under general anesthesia, except that the fetus remains dependent on the placenta and is returned to the uterus. A [[hysterotomy]] is performed on the pregnant woman. Once the [[uterus]] is open and the fetus is exposed, the fetal surgery begins. Typically, this surgery consists of an interim procedure intended to allow the fetus to remain in utero until it has matured enough to survive delivery and neonatal surgical procedures. Upon completion of the fetal surgery, the fetus is put back inside the uterus and the uterus and abdominal wall are closed up.
The mother remains in the hospital for 3-7 days for monitoring and is required to subsequently deliver the baby via a '''second''' cesarean section. Often babies who have been operated on in this manner are born [[premature birth|pre-term]].
Open fetal surgery has proven to be reasonably safe for the mother. For the fetus, safety and effectiveness are variable, and depend on the specific procedure, the reasons for the procedure, and the gestational age and condition of the fetus.
==History==
Fetal surgical techniques using animal models were first developed at the [[University of California, San Francisco]] in 1980.
In 1981, the first human open fetal surgery in the world was performed at University of California, San Francisco under the direction of Dr. Michael Harrison. The fetus in question had a congenital [[hydronephrosis]], a blockage in the urinary tract that caused the bladder to dangerously extend. To correct this a [[vesicostomy]] was performed placing a [[catheter]] in the fetus allowing the urine to be released normally. The blockage itself was removed surgically after birth. <ref>{{cite web |url=http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2005/05/05/BAGG9CK9F41.DTL |title= First fetal surgery survivor finally meets his doctor: 24 years ago, UCSF surgeon saved his life in mom's womb |publisher=[[San Francisco Chronicle]] |accessdate=2006-07-26}}</ref>
Further advances have been made in the years since this first operation. New techniques have allowed additional defects to be treated and for less invasive forms of fetal surgical intervention such as [[fetendo]] and fetal [[image-guided surgery]].
==Defects Sometimes Treated by Open Fetal Surgery==
* [[Congenital diaphragmatic hernia]] (if indicated at all, it is now more likely to be treated by [[fetoscopy|endoscopic fetal surgery]])
* [[Congenital cystic adenomatoid malformation]]
* [[Congenital heart disease]]
* [[Myelomeningocele]] (a severe form of spina bifida)
* [[Pulmonary sequestration]]
* [[Sacrococcygeal teratoma]]
* [[Spina bifida]]
==References==
<references />
== See also ==
* [[fetoscopy]]
* [[EXIT procedure]]
* [[Pediatric surgery]]
{{Obstetrical procedures}}
[[Category:Obstetrics]]
[[Category:Surgery]]
{{treatment-stub}}