Prenatal Surgery - Open Fetal Surgery
Prenatal surgery, to close or cover a spina bifida lesion before birth, can sometimes be carried out in certain circumstances. There are significant risks for both mother and fetus, the benefits are variable and impossible to predict, and the long-term effects are unknown at the present time.
You can also watch this video, courtesy of Gift-Surg for more information.
Open fetal surgery
In 2019, NHS England commissioned a service to carry out open fetal surgery (that is, surgery in the womb) for babies diagnosed with spina bifida. NHS Scotland have joined with NHS England to ensure that the same service is available throughout the UK.
As this is very specialist surgery, NHS in the UK have agreed that 2 centres, one in London and the other in Belgium, will carry out all surgery for patients from the UK.
In Scotland the primary Centre for referrals will be University Hospitals Leuven, in Belgium.
This centre pioneered in utero surgery in Europe and was pivotal in supporting the University College London Hospitals NHS Foundation Trust (UCLH) / Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH) in London in developing their expertise. The two centres now work closely together as a virtual single unit, and some of the same clinicians work at both centres.
Click here for details of the service which is hosted on the UCLH website.
If your baby has had a diagnosis of spina bifida at the midterm (20 week) scan, and you would like to know more about open fetal surgery, please email.
Or call the unit at University College London Hospital on 020 3447 9144.
The service the NHS has commissioned is for the ‘open’ type of surgery. The ‘open’ approach has been commissioned as the current evidence indicates that, compared with other approaches, this has the best outcomes for the baby. ‘Open’ fetal surgery involves making an opening in the mother’s abdomen and womb to operate on the baby’s back and close the lesion.
This surgery is carried out before the 26th week of pregnancy, as the earlier in pregnancy the surgery happens the better the fetal outcome. It is important to know that there are several criteria for surgery, and the surgery will not be right for everyone. If the clinical team decide that surgery is an option there are several checks that will be made to make sure the surgery is safe for you and your baby, and to ensure that your baby is likely to benefit from the surgery.
If your baby has had a diagnosis of spina bifida at the mid-term (20 week) scan, and you would like to know more about open fetal surgery, talk to your Fetal Medicine Consultant about whether the surgery might be an option for you.
You may wish to talk to SBH Scotland (Spina Bifida Hydrocephalus Scotland) on 03455 211 300 or by email who would be more than willing to support you to make an informed choice. You can contact us at any time, before, during or after your discussions with the fetal medicine specialists or other Consultants involved.
Other forms of in utero surgery
Fetoscopic surgery - Fetoscopic surgery for spina bifida involves a ‘keyhole’ approach, operating on the baby’s back through small holes made in the mother’s abdominal wall.
Experimental trials into different approaches to fetoscopic surgery are being undertaken in different parts of the world. As yet, there is not yet enough evidence to fully understand the benefits and risks to the fetus/baby and the mother compared to open fetal surgery.
Fetoscopic surgery is not currently available on the NHS.