In today’s world, there are advanced imaging techniques that allow for better diagnosis of congenital and other related defects that obtain more precise evaluations with which doctors can develop an action plan and take surgical measures even before birth, with great potential to save the baby’s life.
Now, congenital defects represent the main cause of illness and death in the first year of the life of children. This has led to the development of various inventions in the health tech industry to save the life of these babies.
In the case of tumoral masses of the neck, such as cervical teratoma and lymphatic malformations, for example, these can grow so much that at birth the fetus suffers obstruction in the respiratory tract and esophagus, explains surgeon Oluyinka Olutoye, co-director of the Texas Center for Fetal Surgery and adjunct professor of surgery at the Baylor College of Medicine (BCM) in Houston.
The lack of oxygen can cause brain damage in the fetus which can lead to death. In many cases, the size of the mass makes a normal delivery impossible, because the baby can not go through the birth canal.
With proper prenatal diagnosis, breathing obstruction can be corrected and avoided before birth. An unusual procedure known as intrauterine ex-uterine treatment (EXIT) is used, which is relatively new and should not be confused with a regular cesarean section, says Olutoye.
The work team includes obstetricians, pediatric surgeons specialized in fetal surgery, anesthesiologists, cardiologists, neonatologists, nurses, and an additional operating room.
The doctor’s expectation is that the mother is close to giving birth to perform the intervention. She receives general anesthesia, an incision is made in her abdomen and uterus, and special staples are used to prevent bleeding.
Still attached to the mother by the umbilical cord to maintain temperature and gaseous exchange, the fetus is partially extracted -only the head and shoulders- while the rest of her body remains inside.
Surgeons evaluate the degree of obstruction with bronchoscopy, laryngoscopy or tracheotomy, as the case may be, and intubate the small patient to ensure breathing. If another procedure is required to guarantee your breathing at birth, it is done before cutting the umbilical cord.
At the end, the fetus is removed completely, the umbilical cord is cut and doctors decide whether to remove the mass immediately or if they can intervene a few hours or days later. This type of surgery is performed in a few institutions in the world.
“Of every 10 patients, only one receives surgery before birth,” says Olutoye. As in any operation, and also because it is highly “invasive”, it also carries risks of infection. It is also indicated for other problems such as congenital diaphragmatic hernia and malformations in the lungs.
Surgeons at the Texas Center for Fetal Surgery relied on this technique for the first time to remove a rare cyst (immature mesenchymal neoplasm) in a 37-week fetus, which was located on the right side of the chest and pressed on its heart. and lungs, blocking the flow of blood from the abdomen to the heart.
Without surgery, the baby would have died shortly after birth due to heart failure or lack of oxygen.
After the success of the surgery, Dr. Olutoye narrates that the process made him meditate and appreciate the work of God more.
For the US based Nigerian doctor, the important thing is to take advantage of the technology that is available today and try, as much as possible to correct the problems of these babies before they take their first breath. So far, the results have been satisfactory.
Of the 11 cases treated at the Texas Center for Fetal Surgery, 10 have been successful.