New Delhi: In a first for India, doctors at AIIMS Delhi have performed surgery on an unborn baby at 25 weeks of pregnancy to repair a severe birth defect affecting the spine, offering a chance to reduce neurological damage before birth.
The six-hour procedure, carried out on November 12 at AIIMS Neurosciences Centre, treated myelomeningocele, the most severe form of spina bifida.
In the condition, an opening in the baby’s spine allows the spinal cord and its coverings to protrude, exposing nerves to progressive damage.
Both the mother and the foetus are stable and recovering well after the surgery, Dr K Aparna Sharma of the maternal-fetal medicine team said.
Children born with the condition can face paralysis, bladder and bowel dysfunction, and hydrocephalus, which often requires additional surgery.
While the defect is traditionally repaired after birth, prenatal surgery allows doctors to protect the exposed spinal cord during the remaining months of pregnancy.
Professor Deepak Gupta, who led the neurosurgical team, said, “The purpose is to protect the exposed spinal cord from further injury during the remaining months of pregnancy. In carefully selected babies, prenatal repair can reduce hindbrain herniation and the need for treatment of hydrocephalus, while improving early lower-limb function and the likelihood of independent walking.
“It is an opportunity to improve outcomes, not a cure,” he added.
International studies have highlighted the benefits of foetal repair.
The landmark Management of Myelomeningocele (MOMS) trial found that the need for a cerebrospinal fluid shunt to treat hydrocephalus by 12 months was 40% among children who underwent foetal surgery, compared with 82% among those operated on after birth.
Doctors cautioned that foetal surgery carries risks, including premature labour, preterm delivery, bleeding, infection and complications related to the uterine scar.
The procedure therefore requires careful patient selection and close monitoring of both mother and foetus.
More than 30 clinicians and nurses participated, including Professor Neena Malhotra (Maternal-Fetal Medicine and Obstetrics); Professors Vimi Rewari and Mihir Pandia, Dr Rashmi Ramachandran and Dr Gyanendra Pal Singh (Obstetric Anaesthesia and Neuroanaesthesia); Dr Shashank Chauhan (Plastic Surgery); and Dr Ramesh Agarwal and Dr Deepika Kainth (Neonatology).
The surgery was provided free of cost under the Centre’s Janani Shishu Suraksha Karyakram (JSSK). AIIMS said it plans to develop a structured foetal-care programme to offer the procedure to eligible families.
“Fourteen years ago, we spoke of the possibility of foetal spinal surgery at AIIMS. Today, that possibility has become a reality. Our next responsibility is to make it safe and accessible to Indian families who may benefit from it,” the team said.
