Treatment for SB

After evaluation, you will meet with our multidisciplinary team, including a fetal surgeon, a neurosurgeon, an
anesthesiologist, a maternal-fetal medicine specialist and a coordinator. The purpose of this meeting is to review your
test results, confirm the diagnosis, explain treatment options and potential outcomes, and answer all of your questions.
The decision of whether prenatal or postnatal repair is appropriate is influenced by several considerations, including
gestational age, the level of the MMC lesion on the spine, presence of the Chiari II malformation and a number of
important maternal health factors. Prenatal repair also requires a significant commitment on the part of the mother and
her support person.
The Center team helps each family fully understand the benefits and risks of treatment so they can make the best decision
for their unique situation. Our team also counsels and supports families who choose to terminate the pregnancy.
Prenatal Repair If a mother whose fetus has an MMC is a candidate for prenatal repair at The Children’s Hospital
of Philadelphia, the surgery is performed between 19 and 25 weeks’ gestation. Mothers must be willing to stay in
Philadelphia with a support person for the surgery and for the duration of the pregnancy to allow close monitoring.
In prenatal repair, the mother undergoes general anesthesia, which also relaxes the uterus and anesthetizes the fetus. Fetal
surgeons perform a laparotomy (an incision across the mother’s abdomen), the uterus is opened and the baby’s back is
rotated into view. A pediatric neurosurgeon removes the MMC sac, if one is present, and closes the surrounding tissue
and skin over the defect to protect the spinal cord from exposure to the amniotic fluid. The uterus and the abdominal
incision are then closed. A maternal-fetal medicine specialist performs sterile intraoperative ultrasound to map the position
of the placenta and the fetus, and a fetal cardiologist uses echocardiography (ultrasound to assess the fetal heart) to
examine fetal heart function during the surgery. These measures are used to ensure the utmost maternal and fetal safety.
The mother usually remains in the hospital for three to five days and is on modified bed rest for two weeks after surgery
to reduce the risk of preterm labor. For the remainder of the pregnancy, follow-up includes weekly visits to the Center for
ultrasound monitoring and routine prenatal care. The baby is delivered by planned cesarean section at 37 weeks, if labor
does not commence sooner.
Mothers who elect fetal repair will also be asked to sign a consent for postnatal follow-up of the baby by our Center.
This follow-up will require the family to return to Philadelphia for evaluation when the child reaches 12 months,
30 months and five years of age. Detailed follow-up not only provides excellent care for the child, it adds to a growing
base of knowledge that will benefit future generations of children with spina bifida.