Couple in a ultrasound appointment

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Midwest Fetal Care Center physician explains open fetal surgery

The Midwest Fetal Care Center is proud to announce a new open fetal surgery program. The Midwest Fetal Care Center, a collaboration between Children’s Minnesota and Allina Health, started in 2008 and opened a new facility – the Michael and Ann Ciresi Midwest Fetal Care Center – last year. This new program allows moms and families in the Upper Midwest region access to advanced fetal care center services closer to home.

Dr. Joseph Lillegard, pediatric and fetal surgeon and director of research at the Midwest Fetal Care Center, explains more about the new open fetal surgery program and the Midwest Fetal Care Center’s services below.

Q: What is open fetal surgery?

In open fetal surgery, a fetus is partially exposed from the womb allowing for surgery to be performed. After completion of the surgery the fetus is placed back in the uterus for continued growth and development. Ideally babies will stay inside the uterus until 36 weeks gestation is reached. It’s an advanced fetal surgery procedure that fewer than a dozen centers in North America routinely perform. The surgery requires a large and skilled clinical team – including fetal surgeons, neurosurgeons, maternal fetal medicine specialists, nurse specialists, anesthesiologists and more.

Q: What types of conditions does the Midwest Fetal Care Center’s open fetal surgery program treat?

The Midwest Fetal Care Center open fetal surgery program performs open fetal surgery for select cases of spina bifida, including myelomeningocele. Other indications include rare, large tumors that affect the developing fetus’ ability to survive.

Q: What is spina bifida?

Spina bifida occurs in the womb when the spinal column doesn’t form and close completely, which leaves the spinal cord and nerves exposed at any level along the spine. This can cause traumatic injury to the spinal cord, a buildup of fluid in the brain, and other significant physical and neurological damage that is present at birth, severely impacting the life of the child. The cause of spina bifida is related to interplay between genetic predisposition and the environment.

Q: How is spina bifida detected in-utero?

During pregnancy, spina bifida is typically diagnosed by an ultrasound. If a birth defect such as spina bifida is suspected, expectant families are referred to a tertiary fetal care center like the Midwest Fetal Care Center for additional testing to confirm the diagnosis, educate the family about the diagnosis and work with them on a care plan for mom and baby.

Q: Why is prenatal repair for spina bifida recommended for some cases?

Research demonstrates that although open fetal surgery is not a cure for spina bifida, it can yield significantly better results than traditional postnatal repair. It can dramatically reduce the effects of the condition by reducing the shunt rates related to hydrocephalus by 50 percent, improve and reverse the hindbrain herniation, improve neurocognitive function and significantly improve unassisted ambulation rates.

When the diagnosis is confirmed, a cross-collaboration of specialists from the Midwest Fetal Care Center meets to review the case and determine the best treatment options for mom and baby, working closely with the family. This includes a large group of clinicians, such as fetal surgeons, neurosurgeons, maternal fetal medicine specialists and neonatologists, as well as care coordinators, social workers and ethicists.

Q: What happens to the mom and unborn baby after the surgery? What’s the plan for delivery and immediately after birth?

For optimal outcomes, the surgery is usually done between 23 to 26 weeks gestation. Following the surgery, expectant mothers are observed in the hospital and put on bed rest for several days. Most are then discharged to continue their pregnancy at home with limited activity and have weekly ultrasound appointments. The goal is for expectant moms to make it to 36 weeks gestation, at which point the baby is delivered via Cesarean-section.

After birth, the baby is assessed by a variety of specialists such as a neonatologist, orthopedic surgeon, pediatric surgeon, neurosurgeon and urologist. If the baby makes it to 36 weeks for delivery they can typically go home after a five to seven day stay in the hospital.

Q: How many open fetal surgeries has the Midwest Fetal Care Center performed to-date?

The Midwest Fetal Care Center has performed several successful open fetal surgeries in its first year of the program. It’s estimated that there are 60 to 100 pregnancies annually complicated by spina bifida in the Upper Midwest. Nicole Carlin and her daughter Clara were one of the first open fetal surgery cases performed at the Midwest Fetal Care Center – read their story here.

Q: Looking ahead, what excites you about fetal medicine?

The goal in the near future is to advance prenatal diagnosis and fetal medicine so that clinicians can treat conditions like spina bifida using minimally-invasive techniques such as operative fetoscopy. Operative fetoscopy is a minimally invasive surgical intervention that is already performed for other conditions, such as twin-to-twin transfusion syndrome, at the Midwest Fetal Care Center.

Q: Why choose the Midwest Fetal Care Center?

Our outcomes: We have some of the highest survival rates and lowest rates of post-operative complications as reported in literature. Additionally, for premature babies who require surgery, we have one of the lowest rates of surgical complications coupled with neonatal survival outcomes that are among the best in the country.

Coordinated and seamless care: Additionally, our coordinated care approach puts mom and baby first. From surgery to coordinating appointments to working with specialists, nurses, fetal care clinical social workers and others, families receive seamless care from diagnosis through treatment and after-care.

Advanced prenatal intervention: As a comprehensive treatment destination for developing babies and their mothers, the Midwest Fetal Care Center is one of less than a dozen centers in North America that routinely perform fetal surgery to treat diagnoses such as severe forms of spina bifida.

To learn more about the Midwest Fetal Care Center open fetal surgery program, visit our fetal medicine page.

Joseph B. Lillegard, MD PhD, headshot
Joseph B. Lillegard, MD PhD
Kristin Tesmer