New Delhi :- The doctors of All India Institute of Medical Sciences (AIIMS) have achieved a major achievement in the field of health. Here the team of doctors has performed open surgery on the spinal cord of a 25 weeks old baby in the womb. This complex procedure, which lasted for about 6 hours at the Neuroscience Center of AIIMS on November 12, has been described as the first open fetal surgery of its kind in India.
The purpose of this operation was to correct a serious congenital spinal cord disorder in the child before birth. A team of more than 30 doctors, experts and health workers were involved in this complex operation. The surgery was led by Professor Deepak Gupta, Department of Neurosurgery.
From which disease was the child in the womb suffering from?
The fetus was suffering from a congenital disease called Myelomeningocele. This is a severe form of spina bifida. In this, some part of the spinal cord and the membranes covering it come out of the open space made in the spinal cord.
Nerve tissues can be damaged in this disease. After birth, the child may have to face serious problems like paralysis in the legs, difficulty in walking and filling of water in the brain i.e. hydrocephalus.
Usually, the operation for this disease is done after the birth of the child. However, till then there is a possibility of damage to the nervous system. To reduce this risk, AIIMS doctors decided to perform the surgery in the womb itself.
The operation lasted for 6 hours after five weeks of preparation.
According to Delhi AIIMS, preparations for this surgery lasted for more than five weeks. During this, detailed examination of the fetus, ultrasound and other imaging procedures were done. The mother was also explained in detail about the possible benefits and risks of the operation.
The help of high power microscopy and continuous ultrasound was taken during the surgery. Experts from the departments of Maternal-Fetal Medicine, Obstetrics and Gynecology, Neurosurgery, Neuroanesthesia, Radiodiagnosis, Plastic Surgery and Pediatrics were included in it.
Professor Neena Malhotra and Professor K. Aparna Sharma took the responsibility of maternal and fetal medicine. At the same time, experts from different departments cooperated for anesthesia and other technical procedures.
How much better are the results after birth than after surgery?
The main purpose of performing surgery in the womb is to prevent further damage to the exposed nerve tissue. This may reduce the problem of hydrocephalus in the child and may also reduce the need for a shunt to remove excess water from the brain.
According to the international MOMS study, 40 percent of children who had surgery in the womb needed a shunt by 12 months of age, compared to 82 percent of children who had surgery after birth.
However, surgery during pregnancy is not completely risk free. This can lead to premature delivery and complications related to surgery scars in the uterus. Therefore this procedure is done only in selected cases at specialist centres.
There will be continuous follow up of mother and child.
According to Professor Deepak Gupta, after surgery, the mother and child will be continuously monitored from pregnancy to delivery and newborn stage. He said that the entire expense of this operation has been covered free of cost under the Janani Shishu Suraksha Karyakram scheme of the Central Government.
Why is it important to take folic acid before pregnancy?
Experts say that intake of folic acid before pregnancy is very important to prevent this disease. The development and closure of the neural tube occurs in the first 28 days of conception. This time is often before the pregnancy is detected.
Therefore, women should take folic acid as per doctor's advice while planning pregnancy. According to experts, proper nutrition and increasing the availability of folate in foods can also be helpful in preventing such congenital diseases.
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