Introduction:
Fetal lung surgery is a highly specialized technique usually provided in a small number of medical facilities by multidisciplinary teams with extensive training, comprising specialists in fetal medicine, pediatric surgery, and neonatal intensive care unit (NICU) professionals. A relatively new and ground-breaking method in prenatal medicine called fetal lung surgery aims to treat congenital lung problems before the baby is born. It is mainly employed to treat congenital diaphragmatic hernia (CDH), a disorder in which the diaphragm is damaged, causing abdominal organs to migrate into the chest cavity and obstruct normal lung development.
What Is Fetal Lung Surgery?
Fetal lung surgery is a specialized surgical treatment carried out on a growing fetus while still within the mother's womb. It is sometimes referred to as fetal tracheal occlusion or fetal lung intervention. Improved lung development in fetuses with certain congenital lung disorders, most notably congenital diaphragmatic hernia (CDH), is the goal of this therapy.
In CDH, the diaphragm is damaged, allowing abdominal organs to enter the chest cavity and interfere with the lungs' ability to expand and develop. Due to improper lung development, a newborn may experience serious respiratory issues. It necessitates a specialized medical team composed of experts in fetal medicine, maternal-fetal medicine, pediatric surgery, and neonatal intensive care.
What Are the Indications for Fetal Lung Surgery?
The following conditions call for fetal lung surgery:
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Congenital Diaphragmatic Hernia (CDH): The most frequent and important reason for fetal lung surgery is congenital diaphragmatic hernia (CDH). The growing lungs are compressed in this syndrome because the diaphragm is torn, allowing abdominal organs to move into the chest cavity, including the liver and intestines. Because of this, the lungs do not develop normally, which causes serious respiratory issues after delivery. To increase the baby's chance of survival, fetal lung surgery seeks to boost lung development and function before birth.
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Congenital Cystic Adenomatoid Malformation (CCAM): The rare congenital lung disorder known as congenital cystic adenomatoid malformation (CCAM) causes cysts or abnormal masses to develop in one or more lung lobes. In extreme circumstances, CCAM can cause underdevelopment and lung compression, which can impair the newborn's capacity to breathe after delivery. In certain serious situations, fetal lung surgery may be undertaken to enhance lung development and lessen respiratory difficulties.
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Pulmonary Sequestration: Another uncommon congenital lung defect is pulmonary sequestration, in which a portion of the lung tissue has a blood supply that is distinct from the regular pulmonary circulation. After birth, breathing problems and impaired lung development may result from this. In certain severe situations, fetal lung surgery may be an option to improve lung function before birth.
What Is the Procedure for Fetal Lung Surgery?
A group of skilled professionals is required due to the sensitive and complicated nature of the fetal lung surgery process. Due to the necessity for the fetus to be at a viable developmental stage, it is normally carried out between 24 and 32 weeks of gestation. The following are the steps that make up the procedure:
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Maternal Anaesthesia: To guarantee the mother's comfort throughout the treatment, anesthesia is given to her.
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Fetal Positioning: With the use of ultrasound guidance, the fetus is carefully placed so that the afflicted lung may be reached.
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Uterine Incision: To reach the baby's chest and reveal the fetus, a cut is made in the mother's uterus.
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Tracheal Occlusion: To temporarily stop the passage of fluid out of the lungs, a balloon or removable plug is put into the baby's trachea (windpipe).
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Closure: After carefully closing the uterine incision, the pregnancy is permitted to continue till delivery.
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Delivery and Postnatal Care: The baby is born through cesarean section, and any possible difficulties are immediately treated with medical care.
What Are the Risks and Complications of Fetal Lung Surgery?
The following are some of the primary risks:
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Preterm Labor: Fetal lung surgery can cause preterm labor, causing the baby to be born before it is fully developed. The risks and possible problems associated with premature delivery are unique.
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Maternal Risks: The procedure includes cutting a hole in the mother's uterus, which increases the risk of infection, bleeding, or organ damage.
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Fetal Injury: Because fetal surgery is delicate, there is a chance that the fetus might be injured unintentionally during the process, which could have an impact on its health or development.
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Fetal Demise: In some circumstances, fetal lung surgery may result in fetal demise (death of the fetus) as a result of complications or unforeseen effects of the procedure.
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Placental Abruption: The risk of placental abruption, in which the placenta separates from the uterine wall before birth, is increased by uterine manipulation during the surgery.
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Early Membrane Rupture: The surgical operation has the potential to result in early membrane rupture, which might have negative consequences.
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Limited Availability: Fetal lung surgery is a highly specialized technique carried out exclusively in a small number of medical facilities by multidisciplinary teams with extensive expertise. For some families, a lack of availability may provide logistical difficulties.
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Long-Term Results Uncertain: As fetal lung surgery is a relatively new operation, it is unclear how it will affect the baby's health and development in the long run.
How Does Fetal Lung Surgery Work?
Fetal surgery involves several techniques used by surgeons to operate on the fetus inside the uterus. The chosen technique depends on the condition of the fetus and the mother's health. These methods include:
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Open Surgery: This approach requires the mother to be under general anesthesia. The surgeon makes an incision in the mother's abdomen to access the uterus. Another incision is then made in the uterus to reach the fetus. The fetus remains inside the uterus during the operation. After completing the procedure, the uterus and abdomen are closed, and the pregnancy is allowed to continue as close to term as possible.
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Fetoscopic Surgery: In fetoscopic surgery, the surgeon operates through small, minimally invasive "keyhole" incisions in the uterus. A fetoscope, a tiny camera attached to a long, fiber-optic tube, is inserted through the abdomen and into the uterus to treat conditions like twin-to-twin transfusion syndrome or a diaphragmatic hernia. For treating myelomeningocele (spine bones not formed completely), the surgeon exposes the uterus by opening the mother's abdomen and then places the camera and instruments through two to three smaller incisions in the uterus.
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Surgery at Delivery (Exit Procedures): Some fetal procedures are performed during a surgical delivery. The mother is placed under general anesthesia, and medications are given to relax the uterus. The surgeon opens the uterus and partially delivers the fetus. The baby is then stabilized before the umbilical cord is cut, and the baby is separated from the placenta. These procedures can relieve a blocked airway or remove a large tumor that may threaten the baby's circulation or breathing during birth.
Each technique carries its own set of risks and benefits, and the choice of the method depends on the specific medical circumstances of the mother and the fetus.
Conclusion:
Fetal lung surgery is a state-of-the-art medical procedure that has the potential to improve outcomes for fetuses with serious congenital lung disorders. It is still a difficult and dangerous treatment that necessitates careful patient selection and excellent medical care, even though it gives promise for improved lung growth and enhanced survival rates. Fetal lung surgery may become more sophisticated as medical science and knowledge develop, delivering even more positive outcomes for afflicted infants and their families.
