Miniature tools enable Mich. surgeon to operate inside the womb, save 2 fetuses

February 17, 1994|By Knight-Ridder Newspapers

DETROIT -- Doctors have developed ground-breaking techniques involving miniature tools to correct fetal birth defects within the womb.

The new micro-surgical techniques are described in a report in today's New England Journal of Medicine.

As a result of the techniques, two fetuses once believed doomed are healthy babies today, the report said.

The techniques are a variation of the endoscopic surgery that has revolutionized adult surgery to repair gall bladders, hernias and other problems.

Dr. Ruben Quintero, the Hutzel Hospital/Wayne State University School of Medicine obstetrician and gynecologist who developed the new procedures, calls it "operative fetoscopy."

With tiny tools, Dr. Quintero makes one or two cuts, each less than a 10th of an inch wide in the mother's abdomen, through which long, thin scissors, miniature graspers, knot-tiers and tube-pushers can be inserted. One tool has a miniature camera at its end, allowing doctors to actually see inside the fetus.

"This is an historical moment in medicine," said Dr. Roberto Romero, senior author of the report. "Now we can directly visualize inside the human fetus . . . and treat some of the problems we have seen."

The birth defects that might be corrected by the micro-surgery include bowel obstructions and hernias.

Now, as many as three-fourths of fetuses with these defects die in the womb, he estimates.

About 25 miles north of Detroit, in Oxford, Mich., Brittney Maslowski is a living, cooing example of Dr. Quintero's research.

"She's our little miracle," said Lynn Maslowski, 35, an Almont, Mich., teacher who underwent the procedure.

An amniocentesis test during Ms. Maslowski's 16th week of pregnancy revealed that one of the twins she was carrying lacked a skull and that both fetuses were in jeopardy.

In a four-hour procedure, Dr. Quintero and a team of doctors inserted tiny instruments through a slit in Ms. Maslowski's stomach to tie off the umbilical cord of the unhealthy fetus.

Doctors had hoped that fetus would dissolve in the womb, but when Ms. Maslowski went into labor, it came out tiny and deformed. She delivered Brittney by Caesarean section. The baby weighed 3 1/4 pounds and was hospitalized for nearly a month before going home.

The New England Journal of Medicine report describes how the Michigan doctors also saved the life of a South Carolina baby with an identical procedure, just a week before Ms. Maslowski's surgery.

One fetus lacked a heart, skull and arms. His twin was pumping blood for them both, jeopardizing the healthier twin's survival.

The mother, 24, was in her 18th week of pregnancy at the time of her surgery. She delivered a healthy 5-pound baby boy on schedule 4 1/2 months later.

The procedure has its risks. The two mothers required bed rest because their amniotic sacs ruptured after the procedure, though one resealed on its own.

Ms. Maslowski leaked amniotic fluid, the most right after the procedure and in tiny drips throughout the rest of her pregnancy.

Until now, most fetal surgery has involved traditional surgery -- opening a mother's abdomen and correcting the defect. It is risky, complicated surgery.

Without surgery, fetal defects may cause miscarriages, or the babies are born severely handicapped.

The news techniques may prove less risky to both fetus and mother than conventional procedures. In fact, doing surgery early may be beneficial, because the womb is an intensive care unit of its own, Dr. Quintero said.

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