FETAL INTERVENTIONS

Q What are fetal interventions? A These are surgical corrections of congenital defects while the baby is still in utero. Interventions have included transfusions and bladder stents, as well as surgeries to correct heart defects and spina bifida. Q Where are they performed? A Mount Sinai Hospital in Toronto, which has a partnership with the Hospital for Sick Children. The pregnant mother and fetus are treated at Mount Sinai and the baby is rushed to Sick Kids immediately following the birth for followup treatment. Q How was Océane’s heart repaired? A Doctors administered painkillers and an agent to immobilize her. A fine-gauge needle was inserted through her mother’s abdomen. Using an ultrasound as a guide, the surgeons inserted a needle into the left ventricle of Océane’s heart. A guide wire was threaded through the valve and a tiny balloon catheter opened the aorta. Océane remained in utero as long as possible while her lungs matured and she gained weight. She was born by caesarean section and followup surgeries were performed two days and two weeks after she was born. Q Are these procedures risky? A They can be. At the time of Océane’s birth, this intervention had been attempted only two other times in Canada, and failed both times. At the time, similar in utero heart surgeries had been attempted 24 times in the U.S. and only half were successful. Q What is happening in this area? A Mount Sinai and the Hospital for Sick Children now perform more than 100 in utero fetal surgeries and procedures annually. In May 2017, a surgical procedure was performed on Sebastian Havill’s heart five days before he was born to treat a severe form of a congenital heart defect in which the vessels that carry blood away from the heart are not properly positioned. It was a condition that would have prevented Sebastian’s blood from receiving oxygen after he was born. The in utero procedure didn’t correct his condition but it bought some time so surgeons could address it after he was born. If the procedure had not been performed, surgeons would have had to open up Sebastian’s heart within three minutes after birth. The intervention is believed to have been a world first. In June 2017, the team repaired a form of spina bifida called myelomeningocele in a fetus at 25 weeks gestation. The baby’s mother, Romeila Son, recovered well and her baby girl, Eiko, was born weighing 2.45 kg at 36 weeks gestation. Eiko has required no further intervention for the condition, which typically causes permanent damage to the spinal cord and nervous system. Q What’s next? A In March, the province announced $4 million for the creation of the Ontario Fetal Centre to enhance the partnership between Mount Sinai and the Hospital for Sick Children. The centre will be one of only a handful in the world to offer a full range of specialized fetal surgeries and procedures. It will also have the largest training program in Canada.