Pregnancy / Childbirth

In utero treatments, intrauterine treatments

In utero treatments, intrauterine treatments

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Although the history of intrauterine procedures in the world dates back to the 1980s, in Poland this field is not as well known and popular yet, and operations are carried out by teams of specialists in just a few centers. If you want to learn a little more about this intriguing and perhaps for some previously unknown procedure, how they look treatments in the womb, in which cases they are performed and what effects they give, you will find all the necessary information in our article.

What are intrauterine operations?

Intrauterine procedures are various types of procedures performed on fetuses in the intrauterine environment to treat diseases, in the course of which their proper development is at risk, and sometimes also life. The main assumption of the procedures performed already in the womb is preventing damage to the fetus at the earliest possible stage and preventing irreversible damage, both functional and structural.

What diseases can be treated with intrauterine devices?

Already today, thanks to treatments performed on children who are still in the womb, many diseases can be treated and their scope is constantly expanding. One of the most frequently performed treatments is the so-called "needle" procedures, which include various types of decompression procedures, amnioreduction (collection of amniotic fluid in the case of polyhydramnios) and amnioinfusion (administration of fluid solutions in the case of polyhydramnios to the uterus).

Includes here insertion of catheters into individual fetal body cavities in the case of, among others hydronephrosis and an enlarged bladder.

Another type of surgery performed as part of intrauterine interventions areprocedures using foscopy. It is used, for example, when a diaphragmatic hernia is diagnosed in a child. This defect consists in the movement of abdominal organs to the chest, which causes compression of the lungs and the inability to properly develop them. The in utero procedure (in the uterus) is in this case the introduction of a 2 cm balloon into the fetal trachea, which clogs the airway opening and causes an increase in lung volume enabling their better development. Although this procedure is not able to completely heal the hernia and will require surgical correction after birth, it significantly increases the newborn's chances of survival until surgery.

One of the most common indications for foscopic procedures are complications of multiple pregnancies (e.g., twin pregnancies) such as reverse arterial perfusion syndrome (or heartless syndrome, TRAP syndrome) and fetal transfusion syndrome (TTTS, FFTS). Therapeutic procedures in these cases involve closing the vessels connecting the fetal circulation with a laser.

Other diseases that can be treated at the fetal stage in the womb are:hydrocephalus, fetal haemolytic disease, cysts, obstructive uropathies, pleural effusion, and the presence of fluid in the pericardial sac and abdominal spaces.

Are intrauterine procedures difficult and dangerous?

Intrauterine procedures are difficult to compare with ordinary operations, because in this case there are actually two patients on the operating table - the mother and her unborn child. Therefore, they are usually performed in teams of specialist specialists, including anesthesiologist anesthetizing the pregnant and fetus, as well as a gynecologist and surgeon who has the task of correcting any defects. As with any invasive procedure, they also involve here with some risk of complications. Their type and probability depend mainly on the type of procedures performed and the general condition of patients, however the decision to do so is dictated specific indications, and the benefits of its implementation are large enough to be worth the risk taken.

Certainly, the most risky and spectacular treatments are performed on the fetal heart and on the open uterus. Surgeries involving the expansion of critically narrowed heart valves with a special balloon are performed on fetuses after 20 weeks of intrauterine life. They are designed to improve blood flow to the heart and prevent heart failure.

It is also a unique treatment spina bifida surgery between 22 and 27 weeks old.This defect usually occurs around 3-4 weeks of pregnancy and consists in incomplete closure of the spinal canal, as a result of which the spinal cord is not fully covered with muscles and skin. In this case, the exposed core during intrauterine development is exposed to mechanical and chemical damage by the amniotic fluid irritating it. The consequences of the defect may be, among others difficulty moving, paralysis of the lower limbs, impaired sphincter function or even hydrocephalus and mental retardation. In this case, the intrauterine therapeutic procedure involves covering the exposed fragment of the spinal cord to reduce the time of toxic effect of the amniotic fluid and to minimize its damage and related consequences. This procedure is not easy and is associated with the risk of premature delivery, which is why only selected patients in good health condition and without burdens are qualified for it, and the whole staff of highly qualified specialists oversees health and safety during the operation.

Undoubtedly, intrauterine procedures are a huge medical progress and often a great opportunity for unborn babies for better development and life. However, there are specific indications for them, the number of which is constantly increasing. Each patient who could be pre-qualified for such surgery must be carefully consulted and a team of specialists must consider all the potential benefits of its implementation, as well as possible complications and the current state of health of the patients to undergo such procedures.

This article was created in particular for mothers who have to face a difficult choice regarding consent to surgery. We hope that thanks to this they will understand the idea of ​​intrauterine surgery a little better, and the topic may cease to seem as scary as it initially seemed.