Fetal Surgery Offers a Second Chance

While only 18-weeks pregnant, Kelly Hasten and her husband Michael discovered that their unborn daughter had spina bifida, a defect of the spinal cord that occurs when the skin of a fetus fails to close around part of the cord. Surgery after birth--when most of the nerve damage would have already occurred--seemed to be the only option. Or abortion, which they refused. Then the Hastens found an experimental alternative: maternal-fetal surgery.

Until recently, operations were performed on children in the womb only when the child's life was at stake. Now, some physicians are attempting to repair or minimize conditions like spina bifida through a new surgical procedure which involves lifting the uterus out of the mother to better reach the child nestled within.

Dr. Joseph Bruner, Kelly's surgeon, is one such doctor. Since 1994, Dr. Bruner has performed a number of maternal-fetal surgeries, but many were unsuccessful. With the new procedure, the rate of success is improved, but the risk of premature birth is still greatly increased. So much so, that some in the medical community argue that the possibility of positive results does not outweigh the risks.

Still, Kelly and Michael were willing to take the chance, and at 24 weeks, Kelly and baby Abigail underwent surgery. After the amniotic fluid in the womb was suctioned off and set aside, Dr. Bruner incised the uterine wall with an instrument resembling a staple-gun. In fact, it is a kind of staple-gun that both cuts tissue and inserts staples to minimize bleeding.

Beneath the fist-size incision lay Abigail, face down, with part of her back showing, and the spina bifida lesion exposed. Bruner's colleague, Dr. Noel Tulipan, continued. Using delicate and precise instruments, he lifted the tissues surrounding the baby's lesion and carefully closed the hole with tiny stitches. Then Dr Bruner stepped up to close the uterus. A photographer captured this amazing moment, as the baby's tiny hand appeared to be reaching out to shake Dr. Bruner's hand. After gently replacing Abigail's arm, the surgeon sutured the mother's womb and the amniotic fluid was reinjected. The uterus was then pushed back into its home within Kelly's abdomen.

Kelly then had to recover from surgery while waiting through several more months of uncertainty. Within two weeks of the operation, the Hastens discovered that Kelly's amniotic fluid was leaking. Eventually, all of it was lost, leaving Abigail without the liquid cushion that both protects her and helps her develop normally. Now at home and hundreds of miles away from Dr. Bruner's team, Kelly and Michael depended on Kelly's obstetrician, Dr. Frank Andersen, who decided to schedule a Caesarian.

Six weeks shy of her due date and weighing about five pounds, Abigail was lifted from her mother's womb, with a neonatal team standing by. When she didn't begin breathing as she should, they set immediately to work on the infant. At last she started to cry, and everyone breathed a sigh of relief.

But there was more to come. With her fragile lungs under pressure, air had accumulated in her chest cavity. She was placed on a ventilator and a tube was surgically inserted. As she gradually improved over the next few days, her lungs grew stronger. Eventually, she was strong enough to be moved, and fifteen days after her birth, baby Abigail headed for home.

An MRI subsequently performed at the hospital showed no excess fluid on Abigail's brain--a positive sign. It may be years before Abigail's surgery can be truly declared a success, but for now she is doing fine, and her parents are more than pleased.

Photo credit: Alexei Hay for The New York Times

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