Fetal surgery program a first in Cincinnati

A new type of surgery will soon be available in Cincinnati for the most fragile of patients.  

University Hospital, Cincinnati Children's Hospital Medical Center and Good Samaritan Hospital are pooling resources to bring a regional fetal surgery program to Cincinnati. 

This kind of surgery is performed through the mother's abdomen while the fetus is still gestating.  

Surgeons can now reach into the uterus and treat some conditions that would be life threatening to a fetus.  

After the surgery, the fetus is able to continue normal development and the pregnancy can come to term months later. 

Dr. Baha Sibai, chairman of obstetrics and pediatrics at UC, came to Cincinnati from the University of Tennessee three years ago, partly for the opportunity to work with Cincinnati Children's Hospital Medical Center.  

Now he is helping to recruit physicians for the fetal surgery program. 

"We hope that we can start offering something early next year on a regional basis," Sibai said. "We will start with a small percent of pregnancies but will ultimately serve a tremendous number of patients." 

Although fetal surgery has been performed since 1981, few cities have a fetal surgery program.  

The University of California San Francisco, Children's Hospital of Philadelphia and Vanderbilt University have been leaders in the field. 

Now UC will help bring Cincinnati into that elite group. Fetal surgery offers treatment for a limited number of conditions, although the list is expanding as more sophisticated techniques and tools are developed. In some cases, surgeons can now enter the uterus through instruments, such as a fetoscope, that eliminate the need for open surgery. 

One of the earliest anomalies to be successfully treated with surgery was obstructive uropathy, a condition in which a fetus has a blockage, often in the bladder, that impedes urine flow. This potentially fatal condition can cause irreversible damage to the kidneys and lungs. Now doctors can test renal [kidney] function in a developing fetus and intervene. 

"If the fetus has an obstruction in the bladder, we can put a shunt from the bladder to the peritoneal cavity of the fetus." He adds that the shunt will allow the bladder to drain. 

Other treatable conditions are hydrocephalus, caused by an excessive accumulation of fluid around the brain, and spina bifada, which results when the spinal cord is not fully enclosed. The exposure of spinal tissue to the forces of the womb can cause grave damage to the nervous system of the fetus. This is one of the most common birth defects. Now, in some cases, doctors can identify the disorder early in development and close the opening, thus saving the fetus from more damage.  

According to Sibai, developing identical twins share some blood vessels and occasionally there will be an uneven blood flow between them, causing one twin to develop anemia and the other to develop heart failure. This condition causes death to more than 80 percent of the twins involved. Because of advances in fetal surgery, doctors can sometimes intervene and normalize the blood flow. 

As research proceeds and doctors gain more experience with fetal surgery, more babies can be saved.  

"Ultimately, many of these procedures to correct congenital problems can be done in utero. The healing process in utero is 100 percent in that there is almost no scar tissue," Sibai said. 

In the beginning, cases will be carefully screened and only a few will be accepted. Sibai predicts, "As we expand, we expect to attract huge numbers of patients, not only from the region, but nationally."