Clinic Performs Surgery On Fetus Inside Mother’s Womb, Repairs Spinal Cord Defect

A clinic in Ohio performed its first utero fetal surgery to repair a spinal cord defect in a 23-week-old fetus who was delivered at 37 weeks through C-section on June 3.

A multispecialty team of clinicians in Cleveland Clinic repaired a spina bifida birth defect in February in a fetus who was delivered at full term this month, said a press release by the clinic.

The clinic prepared for more than a year to perform its first utero fetal surgery and joined top clinics in North America who can offer such services, said Fox8 Cleveland.

“By successfully repairing the defect before birth, we’re allowing this child to have the best possible outcome and significantly improve her quality of life,” said Dr. Darrell Cass, the director of Fetal Surgery in Cleveland Clinic’s Fetal Center and the leader of the surgical team that performed the repair.

A preparatory meeting of multiple medical teams for Cleveland Clinic's first In-Utero fetal surgery on Feb. 24, 2019. Cleveland Clinic

“There are different measures of quality in determining success for fetal repairs and in this particular case, all metrics for maximum quality were achieved,” he said.

According to the clinic, spina bifida is a birth defect that is usually discovered during a routine check on a child at 18 weeks.

It’s a kind of neural tube defect and can be diagnosed during pregnancy or after birth, according to the Centers for Disease Control and Preventions (CDC).

“The condition affects the lowest part of the spine and occurs when the neural tube does not fully close, causing the backbone that protects the spinal cord not to form as it should. This often results in damage to the spinal cord and nerves and can even lead to brain damage,” said the clinic.

Cleveland Clinic says that spina bifida can affect the person’s ability to walk, as it impacts the strength of the legs and the ability to go to the bathroom and urinate adequately.

A multispecialty team of clinicians performed the surgery in February Cleveland Cinic

Explaining the procedure, the clinic said it begins by exposing the mother’s uterus by making a small cesarean section-like incision that exposes the back of the fetus, showing the spina bifida lesion.

“The surgeons then carefully suture several individual layers of tissue (myofascia, dura and skin) in order to cover the defect. After the uterus is closed back up, the fetus remains in the womb for the remainder of the pregnancy and is ultimately born by caesarean section,” the clinic said.

It said the success of the surgery is based on two metrics–repair to normal brain structure and the gestational age at birth.

“When a successful fetal surgery repair is completed and the brain is examined one month later, the malformation is reversed and the back of the brain returns to a normal appearance, which was observed in this case,” the clinic said about its success on the first metric.

It said the surgery was successful on the second metric as well since the baby was born at the gestation period of 36.5 weeks, which is two weeks more than the normal gestation period. This gave the baby more time to grow and develop.

Dr. Cass, however, said that spina bifida is never fully cured and going forward the baby would need multi-disciplinary care.

CDC says every year 1,645 babies are born with spina bifida in the United States.