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>> FOR THE FIRST TIME IN THE HISTORY OF MANKIND OUTSIDE
OF POSTNATAL REPAIR OF MYELOMENINGOCELE,
WE HAVE A NEW WAY TO OFFER HOPE TO THE FAMILY AND TO THE CHILD
WITH PRENATALLY DIAGNOSED SPINA BIFIDA.
>> EARLY STUDIES THAT WE DID SUGGESTED THAT FETAL SURGERY
MIGHT BE BENEFICIAL, BUT TO PROVE IT,
WE HAD TO DO A RANDOMIZED PROSPECTIVE CLINICAL TRIAL.
>> THE MOMS TRIAL STARTED IN 2003, AND IT WAS A HEAD-TO-HEAD
COMPARISON BETWEEN REPAIR OF MYELOMENINGOCELE AFTER BIRTH
TO REPAIR OF MYELOMENINGOCELE BEFORE BIRTH.
>> AND WHAT THE MOMS TRIAL HAS BASICALLY SHOWED US IS THAT
THE FETAL SURGERY GROUP HAS DONE SIGNIFICANTLY BETTER
IN VIRTUALLY EVERY WAY COMPARED TO CONVENTIONAL TREATMENT.
>> IT'S VERY IMPORTANT THAT THE FAMILY UNDERSTANDS THAT FETAL
SURGERY IS A REALLY, REALLY, REALLY BIG DEAL.
>> THE MOTHER HAS TO GO THROUGH AN OPERATION.
SHE'S AN INNOCENT BYSTANDER IN ALL THIS.
SHE HAS TO UNDERGO A BIG OPERATION TO POTENTIALLY
BENEFIT HER FETUS.
>> IT'S A COMPLICATED MULTIDISCIPLINARY SURGERY.
THERE ARE SIGNIFICANT RISKS OF THE SURGERY ITSELF.
>> WE HAVE TO TELL THEM THAT THEY COULD LOSE THE BABY.
WE COULD DO FETAL SURGERY, AND THEY COULD WAKE UP
NOT BEING PREGNANT.
>> THERE'S A RISK THAT'S SUBSTANTIAL FOR THE FETUS,
IN TERMS OF THE RISK OF PREMATURE BIRTH.
FOR THE MOTHER, THERE IS A RISK OF JUST GENERAL ANESTHESIA
AND A BIG OPERATION.
>> FOR SOME FAMILIES FETAL SURGERY IS NOT GOING TO BE
AN OPTION MEDICALLY FOR THE MOTHER OR THE CHILD.
>> IF THE FETUS DOES NOT HAVE HINDBRAIN HERNIATION,
FOR EXAMPLE, AN ARNOLD CHIARI MALFORMATION,
THAT FETUS WOULD NOT BE ELIGIBLE.
IF THE LESION, THE DEFECT, IS REALLY LOW IN THE SPINE
IN THE SACRAL AREA, A LOT OF TIMES WE DON'T OFFER
THAT SURGERY, ALSO.
>> SOMETIMES, WITH REGARD TO FETAL INTERVENTION,
THE PATIENTS ARE REFERRED TOO LATE.
SO WE WILL NOT DO THE FETAL OPERATION AFTER 26 WEEKS
GESTATION, FOR INSTANCE, BECAUSE THERE APPEARS TO BE
NO SIGNIFICANT BENEFIT.
>> IF THE MOTHER HAS CERTAIN MEDICAL CONDITIONS,
IT MAY EXCLUDE HER FROM BEING OFFERED THIS PROCEDURE--
IF THE MOTHER HAS SEVERE DIABETES OR HAS SEVERE ASTHMA
OR HAS SOME ISSUES WITH OBESITY OR HAS MENTAL HEALTH ISSUES
THAT ARE NOT WELL CONTROLLED.
THERE ARE CERTAIN CRITERIA THAT MUST BE MET.
SO THE MOTHER NEEDS TO BE HEALTHY IN ALL ASPECTS
OF HER LIFE.
>> THERE ARE RISKS INVOLVED, BUT WE KNEW THAT IF THEY THOUGHT
WE WERE A GOOD CANDIDATE, THAT IT WAS POTENTIALLY THE RIGHT
THING FOR US TO DO.
>> A RISK WE WERE WILLING TO TAKE.
>> RIGHT.
>> THERE IS NOTHING MORE IMPORTANT THAN BRINGING THAT
CHILD INTO THE WORLD. AND IF WE COULD GET HIM HERE HEALTHIER,
IT MEANT THE WORLD TO US.