Surgery in the Womb

Operating on the fetus to head off birth defects

Because she was 41 when she became pregnant and thus ran a higher risk of complications than younger women, Rosa Skinner, a housewife in San Mateo, Calif., was sent by her obstetrician to the prenatal diagnosis clinic of the University of California-San Francisco. Ultrasound scans showed that she was bearing twins, a boy and a girl. At 28 weeks the female fetus seemed normal, but the male's kidneys and bladder were swollen with fluid backed up in the urinary tract.

Known as hydronephrosis, the condition can lead to death for newborn babies. Normally, fetal urine flows into the amniotic fluid surrounding the fetus; when the lower urinary tract is obstructed, the urine accumulates in the kidneys and bladder, which then begin to balloon, crowding the fetus' developing lungs and damaging the kidneys. In the Skinner case, doctors chose a new and promising method of treatment: surgery with the fetus still in the womb.

Pediatric Surgeon Michael Harrison used a needle to guide a small blue tube, or catheter, into the fetus' bladder to drain urine into the amniotic fluid. Then he withdrew the needle, using a yellow push rod to hold the catheter in place. On the day after the baby, named Michael, was born in May, Harrison removed the catheter and created an opening for urine to drain from the small of his back. Said Harrison: "Michael will probably have to have another operation to reconstruct his urinary tract, but he should live a normal life."

Only three days after the San Francisco operation, according to the Denver Post, surgeons at the University of Colorado Health Sciences Center used a drainage tube to treat hydrocephalus, a buildup of cerebrospinal fluid in the brain cavity, in a 24-week-old fetus. Says Harrison: "The next step is opening the uterus, fixing something and closing it back up again to allow the baby to develop normally."

For all its promise, fetal surgery poses some difficult ethical dilemmas. Says Roy Filly, an ultrasound specialist who works with Harrison: "Even if the mother wants to have the baby, what do you do if you open up the womb and find the problem is much worse than you feared? Do you save the baby, even though it may be severely handicapped and require extensive lifelong medical care?" Fetal surgery also touches directly on the question of when life begins, a central issue in the debate over abortion. Says Dr. Leonie Watson, a pro-life advocate in San Francisco: "If they can do surgery on a fetus, then it is in fact a baby." Calling that a "phony argument," Phillip Stubblefield, a gynecologist at Boston's Massachusetts General Hospital, submits that a fetus is only a baby if it can live outside the womb. Says he: "Whether or not the fetus is viable is a biological phenomenon that has to do with the maturity of the fetus." One thing seems certain: if fetal surgery fulfills its potential, the right-to-life argument--heretofore wielded by antiabortionists--could be used in favor of medical intervention, rather than against it.

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