Like all babies, Faith’s story begins before she was born. But
unlike others, her history was complicated by a prenatal diagnosis of
myelomeningocele – spina bifida – at the age of 20 weeks. A complex and
permanently disabling birth defect, spina bifida involves
incomplete development of a portion of the spinal cord and associated
as well as the surrounding spinal bones and overlying muscle. At birth,
incompletely developed portion of the spinal cord protrudes through the
Infants born with spina bifida
are at risk for a range of associated conditions, including hydrocephalus,
which may require placement of a shunt to relieve pressure inside the skull
caused by the excess fluid on the brain. They are prone to life-threatening
infections and may suffer loss of sensation or paralysis below the level of the
spinal cord defect, as well as ambulatory problems, deformities of the hips and
lower back pain, leading to lifelong disability.
devastated when we learned our baby had spina bifida,” says Faith’s mother
Colette, who is a resident of Dallas. “Our emotions were all over the place. We
had gone for a routine ultrasound to find out the gender, and the radiologist
noticed an abnormality. When we learned of the possibility of spina bifida, my
husband started doing research on the Internet.”
obstetrician/gynecologist referred her to a maternal-fetal medicine specialist
at Baylor University Medical Center in Dallas, who confirmed the diagnosis and referred
her to the Texas Fetal Center at Children’s Memorial Hermann Hospital and The
University of Texas Health Science Center at Houston (UTHealth) Medical School.
their two-day visit, they met with pediatric surgeon KuoJen Tsao, M.D.,
and other members of the hospital’s
multidisciplinary team to determine a treatment plan. The medical team would
become the first in Texas to perform an in
utero spina bifida repair.
Dr. Tsao had
begun screening patients for in utero
repair in early 2011, based on the results of a landmark study that found major
benefits for fetal surgery in patients with spina bifida. The results of the
Management of Myelomeningocele Study (MOMS) were published in an article
entitled “A Randomized Trial of Prenatal versus
Postnatal Repair of Myelomeningocele,” which appeared in the February 9, 2011,
issue of the New England Journal of
Medicine. Colette and Ivan learned of the MOMS trial during their Internet
support from the National Institutes of Health, MOMS studied the effects of
fetal surgery for the repair of spina bifida to the standard-of-care surgery
for the disorder after birth. The study found that if a baby undergoes surgery in utero, the serious complications
associated with spina bifida could be reversed or lessened with the operation.
Fetal surgery decreased the need for shunting at 12 months for the infants who
participated in the study, and nearly half were able to walk without crutches
by age two-and-a-half.
MOMS study is exciting because it is the first to show that fetal surgery can
result in greatly improved outcomes,” says Dr. Tsao. “But in fetal surgery,
there are risks to the mother and the baby, and we weigh those risks
physicians were up front with the couple about the risks, which include
infection, bleeding, miscarriage, stillbirth, placental abruption, uterine scar
separation/rupture, preterm ruptured membranes and preterm birth. Medically,
Colette was a good candidate, and the surgery itself was straightforward, Dr.
Tsao says. A special stapling device was used to cut through the uterine wall
and close blood vessels to prevent bleeding. Once the fetus was exposed, the gap
in her spine was closed, and the surgical team returned the one-pound baby to
couple says they relied in large part on their faith in making the decision to
go forward with the surgery. “I had a lot of anxiety, especially about the
anesthesia,” Colette says. “Once I learned about the possibility of in utero repair, I wanted to do it. By the time I got to Houston, I had already
made up my mind. And once I make up my mind, that’s it. We wanted to give our
baby the best chance possible.”
gave birth almost nine weeks later, on July 4, 2011, two weeks prior to her
34-week planned delivery date. “We named her Faith because at many points in
our journey, it was faith that kept us going,” she says.
“When I think back about the surgery, my
lasting impression was of the outstanding care I received from the doctors,”
she adds. “It was more than a check-in, check-out relationship. It was genuine
caring, and we’ve been singing their praises ever since."