Unborn children get new surgery - deadly hernia corrected in womb

Surgeons have developed an operation to repair a potentially fatal abnormality in babies before they are born.

Some babies develop a hole in their diaphragm which leads to their gut or liver moving into their chest, and squashing their lungs.

The new operation, pioneered at London's King's College Hospital, has reduced death rates in the most at risk by 50%.

The condition, known as a congenital diaphragmatic hernia (CDH), is a relatively common foetal abnormality - occurring in about one in every 3,000 pregnancies.

Usually, the diaphragm - a muscular sheet which separates the chest from the abdomen - is fully formed by about nine weeks of development.

But in this condition, a small hole remains, and as the foetus develops the contents of the abdomen, the gut or the liver, force their way through the gap, and up into the chest.

This a problem because, unlike the abdomen, which can expand, the chest is a boney box.

Therefore, when the gut contents enter the chest cavity they compress the lung tissues, and prevent them from developing properly.

As a result, around 50% of babies born with the condition cannot breathe properly, and die.

It has been developed by Professor Kypros Nicolaides, at King's, in collaboration with doctors at University Hospital Gasthuisberg, Leuven, Belgium, and Vall d'Hebron Hospital, Barcelona.

The operation, known as fetoscopic tracheal occlusion, involves inserting a balloon down the foetal windpipe when the foetus is at around 26 weeks of development.

This stops fluid generated in the lungs from escaping into the mouth, and out into the amniotic fluid surrounding the developing baby.

The fluid contains chemicals which stimulate growth of the lung tissue, and provides vital nutrients to speed the process.

Blocked from leaving the lungs in the normal way, the fluid stimulates the lung tissue to develop to such an extent that it begins to expand, and eventually to push the gut contents back through the hole in the diaphragm.

Initially, the balloon was removed from the baby's windpipe when the child was born, but the surgeons have now switched to a policy of removing it about a month before full term. This allows the child to be born naturally, rather than through a Caesarean section.

Professor Nicolaides told BBC News Online that three of the first 10 babies who underwent the surgery survived, but the six of the next 11 pulled through.

He is confident that 60-70% of babies most at risk will now survive after undergoing surgery.

He said: "This focuses on an important aspect of foetal medicine which is not to do with searching for abnormalities in order to destroy foetuses, but to diagnose them as early as possible and to develop minimally invasive procedures to correct them."

Professor Stuart Campbell, Editor of Ultrasound in Obstetrics and Gynaecology, said: "This relatively common foetal abnormality can be devastating to parents who until now could be offered little hope that their babies would survive.

"With the help of better scanning techniques we can accurately diagnose most foetal anomalies and we are now moving into the next phase where some of the abnormalities can be successfully treated in the womb."

Link from article above:

Tuesday, 26 February, 2002, 12:37 GMT

http://news.bbc.co.uk/2/hi/health/1842057.stm

Heart operation on five-month foetus

Foetal operations are becoming more common

Doctors believe they have successfully carried out a heart operation on their youngest-ever patient - a 23-week old foetus. The procedure, carried out in Boston, US, in summer 2001, may have prevented the development of a heart defect which could have proved fatal.

The baby, called Jack, has now been born, and appears to be thriving.

Similar procedures have been carried out before - including several in the UK - but with limited success, and on older foetuses.

In order to reach Jack's heart - which, at 23 weeks, would be little bigger than a grape, cardiologists inserted a tiny catheter tube into the abdomen of his mother, through to the womb, and on into the organ itself.

A tiny wire was then pushed through the tube, and guided towards an obstructed heart valve - a target likely to be no more than 2mm to 3mm in diameter.

Doctors guide the catheter and wire using images produced by an ultrasound scanner.

Once across the valve, a minute balloon was inflated to widen the valve, then the balloon, wire and catheter pulled back out.

In total, it took no more than 20 minutes for a team of 12 doctors, nurses and technicians to complete.

Problem spotted

Doctors were able to operate on Jack because routine pregnancy scans had spotted the telltale signs that his heart was not developing properly.

In fact, he was in the early stages of hypoplastic left heart syndrome - one of the most life-threatening heart defects.

The blocked aortic valve prevents the left side of the heart from doing its job properly - pumping oxygen rich blood out around the body.

The malfunction means that the powerful left hand side muscles gradually stop working properly, normally withering away and becoming useless.

Only the limited pumping action of the right hand side of the heart keeps the baby alive.

By the time the baby is born, the damage has been done, and while there are complex operations to try to correct the problems, these still carry high mortality rates.

The foetal operation, despite being carried out on such a small heart, is relatively simple in comparison with the reconstructive or transplant operations needed once the baby is born.

Opening the valve so early meant that the normal development of the left hand side of the heart was allowed to continue.

There is a chance that the valve will close up again, but that has not happened so far - and doctors are hopeful that Jack will have a normal childhood.

Original team

Dr Lindsey Allan, a foetal cardiologist from the Harris Birthright Centre at King's College Hospital in London, was one of the original team who carried out the first operation of this type - on a 26 week old foetus - at Guy's Hospital in 1991.

She told BBC News Online that while the US operation was encouraging, this was likely to remain a very rare procedure.

She said: "You have to identify them early enough so that it will make a difference, and now success rates of other options are improving, there will be fewer parents willing to choose this method.

"But where there are suitable patients, this could be a route to go."

This plus a growing mountain of irrefutable scientific evidence shows just how utterly wrong Roe v Wade was and always will be.

Unborn Children are routinely treated in hospitals as patients. They have patient charts and of course there are the medical bills to go right along.

We see 4D Ultrasounds in real time video of children waiting to be born and learn that they are operated on. Yet if the mother were to decide tomorrow that she no longer wants to be pregnant the baby somehow becomes a blob of tissue to be discarded?

Hey kid, we born people are so “free”...that we can operate on you to make you a healthy baby, or we can dismember you and throw you out with the trash, or keep ya for experiments...whatever. Whatever your mom says—best of luck, kid.

Apathetically yours,

Godless AmeriKa

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