In 1981, Michael Skinner was recorded in medical history before he had a name or uttered his first cry. While still in the womb, two weeks before birth, he underwent surgery to open his obstructed urinary tract. Without that surgery, little Michael would have suffered irreparable kidney damage and possibly death.
Michael's abnormality was detected when pediatric surgeon Dr. Michael Harrison and perinatologist/geneticist Dr. Mitchell Golbus, both of the Fetal Treatment Program, University of California, San Francisco, scanned the mother with ultrasound--a diagnostic tool that bounces sound waves off the fetus to obtain a detailed picture of life inside the womb. The doctors saw that she was carrying twins, but that one infant was suffering from hydronephrosis, or blockage of the urinary tract. When such a blockage is total, it causes fluid backup damaging both the kidneys and lungs. Although it is difficult to evaluate the number of babies that may have the condition (so many die before birth), an estimate is one out of every two thousand.
The doctors knew they had to act fast or risk losing the baby. With the parents' informed consent, the doctors inserted a needle through the mother's womb and into the bladder of her unborn son to drain off the fluid. Next, they inserted a catheter (a slender spaghetti-like tube) and a shunt into the unborn's bladder to assure continued fluid drainage until birth.
Two weeks later, the twins were born. Healthy baby Mary weighed about five pounds and went right to the nursery. Michael was basically fine too, except for some minor problems, like ballooning abdominal walls from fluid pressure. The doctors immediately removed the shunt and partially repaired his abdomen. Today, after further corrective surgeries, Michael leads a normal, active life.
Heralded as one of the most promising medical breakthroughs of the decade, fetal surgery has saved hundreds of babies' lives by treating the fetus in utero. It offers an option to families with diagnosed disorders in their unborn child, who might otherwise choose to terminate their pregnancy rather than watch their newborns suffer or die.
The first step toward fetal surgery was the development of such prenatal diagnostic methods as amniocentesis (drawing a sample of amniotic fluid surrounding the fetus examine fetal cells for abnormalities), ultrasound, and chorionic villus sampling (a delicate drawing off in the first weeks of pregnancy of developing fetal tissues that later in pregnancy form the placenta). These techniques detect, during pregnancy, certain birth defects that had previously been revealed only after birth. Generally, such techniques are reserved for women with high-risk pregnancies: older mothers, mothers with diabetes or heart problems, or those with a family history of genetic diseases that present a risk to the fetus.
After these prenatal diagnostic techniques were developed, the move to corrective surgery was a logical next step. Dr. Harrison remembers when the first pioneers of fetal surgery met together in 1981. They had already learned, after twenty years of studying animals, how to remove, observe, and return the fetus to the womb.
They summarized while some fetuses would thrive with surgery after birth, others would die
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