Prenatal Surgery - History Of Fetal Surgery, Closed-womb Surgery, Open Surgery, Ethical Issues, Future Developments - Fetal reduction
fetus fetuses kill pregnancy
Prenatal surgery, also called fetal surgery, is medical treatment of the fetus before birth, while it is still in the womb. Most fetal therapies are "closed" procedures, performed without opening the womb. The rarest type of fetal surgery is known as "open surgery," in which the mother's abdomen and uterus are cut open to reveal the tiny fetus.
The success rate of open surgery
When doctors began performing open surgery, in the early 1980s, most of the fetuses died. Some physicians were critical of the attempts. They argued that a healthy woman was put at risk in order to attempt the rescue of a fetus that would most likely die anyway. Others supported the experimental surgery and declared that this was the fetus's only chance.
Today, open surgery remains a last resort for a small number of birth defects. It is appropriate only if it can result in the normal development of the fetus. Surgery that prolongs the lives of babies suffering from incurable health problems is not acceptable. Neither is surgery that puts the mother at excessive risk. In many cases, medical treatment after the baby is born offers an equal chance of success, provided that the pregnancy is carefully supervised and that delivery is planned at a well-equipped hospital with a neonatal intensive care unit.
Fetal reduction, the systematic killing of one or more fetuses in order to save those remaining, also raises ethical issues. To a certain extent, the issues duplicate those involved in the abortion debate: when is it ethical to kill a fetus? If a woman plans to abort the whole pregnancy unless a fetal reduction is done, is it wrong to kill some fetuses so that others may live? Many fetal surgeons will not perform fetal reductions.
Additional Topics
The first successful fetal surgery, a blood transfusion, was performed by A. William Liley in 1963 in Auckland, New Zealand. He used x rays to see the fetus and guide his needle. Liley's success was unparalleled for years, however. Most doctors considered the pregnant womb as sacrosanct and untouchable. To treat the fetus as a patient, separate from its mother, was unthinkable. That view be…
More common than open surgery, closed-womb procedures are still rare enough to be practiced at only a few dozen specialized institutions. Sometimes these procedures are called "needle treatments." Since the first fetal blood transfusion in 1963, fetal transfusions have become one of the most accepted types of fetal therapy, although they are still uncommon. Transfusions can save the …
Open surgery is highly experimental. As of 1994, medical researchers had reported only about 55 operations in the previous 14 years. The vast majority of these were performed by pediatric surgeon Michael R. Harrison and his team at the Fetal Treatment Center at the University of California, San Francisco. Harrison's team has performed open surgery, at least once, for seven or eight differen…
Certain aspects of fetal surgery raise thorny ethical issues. Treating a fetus as a patient creates a situation that has never before existed. In the past, experimental treatments for the seriously ill could be justified on the grounds that the patient had everything to gain and nothing to lose. With fetal surgery, that may hold true for the fetus, of course, but the benefits and risks to the moth…
Fetal surgery is no longer limited to a few techniques. With advances in knowledge and improvements in equipment, new opportunities for the treatment of more birth defects will emerge. The unexpected discovery that fetuses heal without scarring suggests that cleft palate and other facial defects might be conducive to repair in the womb. Further research is needed, however, before surgery can be ju…
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