Nearly 40 children underwent in utero surgery in Bytom
Already nearly 40 children underwent in utero surgery in Poland. The only centre in the country carrying out such operations is the Department and Clinic of Gynecology, Obstetrics and Gynecology Oncology in the Hospital No 2 in Bytom.
The indication for in utero surgery is myelomeningocele. In the opinion
of specialists in Bytom, the operations carried out so far fulfil their
purpose, significantly reducing the risk of hydrocephalus in children
and the need to implant a shunt into the child's head at birth.
"Ventricular catheter had
to be implanted in only 29 percent children operated in utero. In the
case of children treated traditionally after birth, it is over 80
percent" - said neonatologist Dr. Gabriela Ziomek.
"With surgery,
active hydrocephalus occurs less often in these children; time, in
which the implantation of a shunt is needed increases as well. None of
the children, who underwent in utero surgery, needed a shunt in the
neonatal period, in the first 28 days of life. The earliest implantation
was performed on the 30th day of life, the latest on the 172nd. In
traditional surgical treatmnt, it is sometimes necessary within first 10
days of a child's life, sometimes within first 48 hours of life, which
increases the risk of complications in the newborn" - she added.
Operations
in Bytom are performed between 22nd and 27th week of pregnancy,
majority were carried out between 24th and 26th week. For the treatment
to be possible, the mother must be healthy, and other serious birth
defects must also be ruled out. "Unfortunately, many women who could
undergo this surgery, do not come to us, or comes too late. There is
insufficient awareness among doctors and patients. These procedures are a
chance for a better life for children" - said the head of Bytom
department of gynecology and obstetrics Prof. Anita Olejek from the
Medical University of Silesia.
She reported that in Poland, each
year about 700 children with myelomeningocele at various portions of the
spinal column are born.
Prof. Olejek emphasised that the present
results of Polish studies - albeit on a smaller number of children -
are even more promising than American. In the U.S., the shunt must be
surgically implanted in nearly half of the children, who undergo in
utero surgery. Results of American study entitled "Moms Trial" were
published in the New England Journal of Medicine.
"This is a very
important study, the whole world has been waiting for the results. They
confirmed the clear benefits of prenatal treatment of myelomeningocele.
The Americans planned to examine a group of 200 children, which is very
significant, they completed the study with only 153, because the
benefits for children were so spectacular that there was no need to
further prolong the study. The percentage of cases of hydrocephalus
requiring treatment at birth was smaller, and psychomotor development of
children treated in the womb is much better" - emphasized Prof. Olejek.
Mmyelomeningocele
is a birth defect occurring around the fourth week of foetal life. The
spinal cord does not close during foetal life and is not covered with
muscles and skin. It remains exposed and therefore develops incorrectly,
because the amniotic fluid damages the nerve endings.
This
defect in children is usually surgically treated shortly after birth.
Doctors cover the spinal cord, thus preventing infections that could
quickly lead to child’s death. However, changes that have occurred in
the spinal cord in fetal life can not be healed.
Children with
this defect suffer from hydrocephalus and paralysis of the legs, often
associated with deformities. Hydrocephalus increases the risk of mental
retardation. Brain tissue does not have space to develop due to the
pressure of excessive amount of cerebrospinal fluid. Therefore, patients
are implanted with ventricular catheter, which drains the excessive
fluid into the peritoneum, from where it is further excreted. With
proper treatment of hydrocephalus patients can achieve full mental
abilities.
The result of spina bifida is also sphincter
paralysis, inability to hold stool, and urinary disorders - inability to
hold urine or blocking urination, dangerous to the kidneys. Operations
and research have continued for too short to say whether in the future
children treated in the womb will be able to control bowel movements and
urine. Based on observations of children who have already undergone
treatment, the doctors say that the results are "promising".
According
to Dr. Ziomek, the extent to which the operations carried out in the
womb improve the efficiency of the legs requires further observation.
Surely, the children require intensive physiotherapy.
During the
surgery, gynecologist incises the uterus in a place where there is a
spina bifida so that it is clearly visible to the paediatric surgeon.
After covering and stitching the spinal column of the foetus, mother's
womb is stitched. Due to the specific environment inside the uterus,
after the birth the scar on a child's body is small.
Doctors
admit that the treatments are associated with certain risks, including
premature birth, burden to a mother, who undergoes two operations in a
few months, because all children with spina bifida are born by caesarean
section.
"However, neither our observations and nor the results
from the U.S. report serious burden for the mother. A child is
threatened mainly with prematurity. Therefore, parents receive detailed
information about the potential benefits and risks" - emphasised Prof.
Olejek.
Daughter of Mr. Paweł from Puławy was the 39th children
operated in utero in Bytom. "We learned of our daughter’s defect a month
ago. In the clinic she underwent all tests and we were sent for
consultation to Bytom to learn whether this operation was possible. We
had doubts, because we were told that nothing was certain. It was a very
nervous situation, but we are decided to through with it. It increases
our child’s chances"- he told.
"Operations of children in
the womb have changed our thinking about the fate of children burdened
with serious defects. We can treat them effectively before birth. In
most Western European countries abortion was proposed to mothers. Such
treatments offer a choice to mothers and a chance for a better life to
children" - said Prof. Anita Olejek. (PAP)
last modification: 2011-03-25
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