Since 1981, in-the-womb surgery has been used for a variety of conditions, including spina bifida, heart and circulatory problems, hernias, intestinal blockages, selected tumors, and other malformations.
Newly developed minimally invasive techniques have helped to reduce the risk of surgical intervention with the use of small needles and cameras to enter the womb and, sometimes, the fetus, to try to correct a developing problem.
Using high-resolution ultrasound, center physicians are able to detect fetal anomalies earlier in pregnancy and with much greater accuracy. When a problem is found, the multidisciplinary team with pediatric specialists and others establishes a treatment plan.
Center physicians care for a wide range of conditions, including:
- Twin-twin transfusion syndrome
- Spina bifida
- Congenital diaphragmatic hernia
- Congenital pulmonary airway malformation (CPAM)
- Posterior urethal valves
- Fetal heart defects
- Brain malformations
Twin-to-Twin Transfusion Syndrome
Twin-to-twin transfusion syndrome (TTTS) is the result of an intrauterine blood transfusion from one twin (donor) to another twin (recipient). TTTS only occurs in identical twins with a monochorionic placenta. The donor twin is often smaller with a birth weight 20% less than the recipient's birth weight.
Twin-twin transfusion syndrome is an imbalance of blood flow between fetuses through shared blood vessels, resulting in a high risk of injury and sometimes death. This can occur in twins that share a single placenta.
Normally blood vessels fan out from each twin's umbilical cord and connect to the placenta. But sometimes vessels of one twin find vessels of the other and form connections, causing blood to pass freely from the "donor twin" to the "recipient twin."
Laser surgery may be a successful way of treating TTTS. This is done by identifying the connections making one baby donate blood to the other baby, and then block the transfusion by using the light of a laser to burn and seal off the wayward blood vessels.
A team of specialists at UPMC Magee-Womens Hospital and UPMC Children’s Hospital of Pittsburgh have performed UPMC’s first in-utero surgery to close an open neural tube defect in a baby months before her birth.
Spina bifida affects about 1,500 babies born each year in the United States. At UPMC Children’s Hospital of Pittsburgh, physicians’ close defects like this one in 10 to 20 infants each year following delivery.
This procedure has been performed at several centers across the United States, but has not been available in this area. In January 2019, an interdisciplinary team of maternal-fetal medicine, obstetric anesthesiology, neonatology and pediatric neurosurgery specialists from both UPMC Magee and UPMC Children’s performed and assisted during the complex surgery.
Pregnant women diagnosed with fetal spina bifida might very well be candidates for the in-utero procedure. UPMC is excited to now offer this service at UPMC Magee to patients living in the western Pennsylvania and tri-state regions.
For more information, please call 412-641-3382.