Unborn Baby Operated Inside in the Womb to Remove a Urinary Block

A 21-week old fetus (unborn baby) was operated upon by a group of surgeons to remove a small block in the urinary passage. This surgery, in turn, has made India achieve a significant milestone and thereby bringing it on par with a few other nations that have achieved this feat. The 28-year old patient, a woman from Kerala$B!G(Bs Thrissur district currently residing in Dubai, is 21 weeks into her pregnancy. During a check-up, the Amrita doctors discovered that a valve in the urethra (the tube that carries urine from the bladder to the exterior of the body) of the unborn baby was obstructing the urine flow and causing damage to the kidneys, as evidenced by a reduction in fluid in the uterus. Analysis of fetal urine showed that the kidneys still had a chance to recover.

Said Dr. Mohan Abraham, Professor & HOD, Pediatric Surgery, Amrita Institute of Medical Sciences, who led the team of surgeons: $B!H(BDue to the blockage in the urethra, the kidneys of the 21-week-old fetus were getting damaged. The condition may have turned fatal if left untreated. We, therefore, decided to conduct surgery on the unborn baby in the womb itself to remove the obstruction, and not wait for the birth. A team of six surgeons from the department of pediatric surgery and fetal medicine operated on the fetus in an operation that lasted an hour. A laser fiber was inserted through the mother$B!G(Bs abdomen and uterus into the urinary bladder of the fetus, and the obstructing valve was removed using a laser. This has allowed the fetus to produce urine normally and the kidneys to recover. It will also improve the development of the lungs.

Said Dr. Vivek Krishnan, Professor, Fetal Medicine, Amrita Institute of Medical Sciences: (though the incidence of fetal anomalies requiring fetal surgery is 1 in 5,000 live births, this is the first time in India that an unborn baby has been treated at 21 weeks of pregnancy in the mother$B!G(Bs womb. It is a big step in the care of the unborn baby, not only in preventing damage to the kidney but also making it very affordable at a fraction of the cost compared to regular renal treatment. Currently, the global destinations for fetal surgery include countries like USA, Brazil, Spain and the UK. With this feat, India too has arrived on the worldwide stage of fetal surgery.

Added Dr. Bindu S, Associate Professor, Pediatric Surgery, Amrita Institute of Medical Sciences: (BEvery fetal surgery can lead to premature delivery, so we had to carefully consider the benefit of surgery against the risk of premature labor. Fetal tissues are like cheese – they can be easily torn and cut. Surgeons need to be very precise and gentle in each movement, which makes fetal surgery very challenging. We are delighted that the surgery was successful. We will now conduct regular follow-ups of the fetus to assess the growth and function of the kidneys.

The operating team consisted of Dr. Mohan Abraham, Dr. Bindu S, and Dr. Aswin Prabhakaran from the Department of Pediatric Surgery; Dr. Suresh, Dr. Vivek Krishnan and Dr. Sushmitha Namdeo from the Department of Fetal Medicine; Dr. Rajesh K and Dr. Maria from the Department of Anesthesiology; and Staff Nurse, Anumol KM.

Source-Medindia