Auckland mum pioneers pathway to access in-utero surgery in Australia

Auckland mum pioneers pathway to access in-utero surgery in Australia

An Auckland mum has safely returned home from Australia after becoming the first New Zealand woman to undergo in-utero spinal surgery for her unborn baby diagnosed with spina bifida.

A team from Mater Mothers’ Hospital, led by Director of Maternal Fetal Medicine Dr Glenn Gardener and Neurosurgeon Dr Martin Wood performed in-utero spinal surgery on Catherine Harper and her 24 week-old in-utero baby on 29 December 2016.

The surgery was the first international case for the Australian team, and their third open fetal surgery since the Australian first in July 2016.

Spina bifida is a condition where the lower part of a baby’s spine is open and it affects 1 in every 2000 pregnancies in Australia. The effects of spina bifida on a child are significant and can include inability to walk and the need to drain fluid from the brain. Families often discover the diagnosis of spina bifida at their 18-20 week pregnancy ultrasound scan and repairing the spinal defect is usually undertaken after the baby is born.

Catherine and Paul received their baby’s diagnosis of spina bifida at the 19 week scan and have been on a whirlwind journey since, with a small window of opportunity for in-utero surgery between 23 and 25 weeks gestation.

“The scan was going really well but just at the end the sonographer said she wasn’t happy with baby’s brain and skull. Our baby was diagnosed with spina bifida and we were told the worst case scenario… but every case is different,” said Catherine.

The expectant mother started researching and found the MOMS study.  The seven year trial in the US demonstrated that in-utero surgery, in comparison to surgery post-birth, halved the need for a child to have a brain shunt and doubled a child’s chance of walking without the need for assistance.

 “Long-distance travel overseas to have the surgery wasn’t feasible for us so I kept searching and Dr Glenn Gardener’s name popped up and I looked at the date−23 July 2016− Mater Mothers’ Hospital in Brisbane had performed the first fetal surgery in Australia and it was successful!”

Within 24 hours Dr Gardener had assessed Catherine’s case files and spoken with the Harper family.

“We went over to Australia on 19 December for further testing and then came home to have Christmas with our little boy Jackson. On Christmas Eve Dr Gardener called to say we met the criteria for surgery and it was scheduled for 29 December,” said Catherine, “It all fell into place very quickly.”

During the delicate two-and-a-half hour surgery, Dr Glenn Gardener marked out a site to open Catherine’s abdomen and uterus to safely expose the baby’s back. Neurosurgeon Dr Martin Wood then stepped in to close the spina bifida defect on the spine, before the amniotic fluid was replaced and the womb was carefully closed.  Both the mother and baby were asleep during the procedure through the use of anaesthetic agents that also cross the placenta.

Mater-Mothers-Hospital-in-utero-spinal-surgery_CH-2.JPG

Neurosurgeon Dr Martin Wood and Maternal Fetal Medicine Director Dr Glenn Gardener
operating to repair the spina bifida defect.

The Harpers say they are blown away by the care and kindness of Dr Gardener, Dr Wood and the team at Mater Mothers’ Hospital.

 “I know Glenn and his team were on annual leave at the time of the surgery and they all said they’d come back for it. We’ve just been so lucky. I don’t know how we’ll ever repay the team at Mater. Now I can say I’ve tried everything possible in my power to help this baby before he’s been born.”

Dr Gardener said it’s been a big year for Mater’s Maternal Fetal Medicine team.

“Mater has completed the first in-utero surgery for Australia and our first international surgery. While this surgery isn’t a cure for spina bifida it can significantly improve the outcomes for babies with spina bifida and I’m delighted we have been able to perform this surgery for a New Zealand family.”

Catherine and Paul are sharing their story with the hope of helping future parents in their position.

“Check out your options and inform yourself; don’t just rely on the professionals. It’s not for everyone and that’s understandable− it’s a big thing. But it felt like the best option for us,” said Catherine.

“We’re the first Kiwis to have had in-utero spinal surgery for spina bifida. We want to get the word out that there is a pathway for New Zealand families to access this surgery at Mater if they meet the criteria.”

Prenatal surgery for spina bifida was pioneered by a team at Vanderbilt University Hospital in the USA in 1997.  The Vanderbilt team travelled to Mater Mothers’ Hospital Brisbane in July 2016 to assist in Australia’s first case. As the first and only hospital offering the surgery in Australia, Mater Mothers’ Hospital in Brisbane provides a closer option for Australian and New Zealand families, reducing the need and cost of travel for in-utero spinal surgery for spina bifida

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