What About Mom?
During fetal surgery, the child is not the only patient at risk.
Anne Drapkin Lyerly doesn’t like the term fetal surgery. That in utero interventions aren’t described as maternal/fetal procedures is a problem for the associate professor at the Trent Center for Bioethics, Humanities and the History of Medicine at Duke University. “Many institutions that perform these procedures have taken care to depict the fetus as an independent patient who will be under the care of prenatal pediatricians,” Lyerly says. “But who is taking care of the mom?”
Little data has been gathered on risks to the mother, even though surgery to repair spina bifida in utero, in particular, involves “a major surgery in the middle of pregnancy and delivery by C-section,” Lyerly says. The only fetal intervention that has resulted in maternal death has been the laser procedure for twin-twin transfusion syndrome. “But there was no unifying thread or plausible mechanism in the four deaths that could be linked to the procedure,” says Nick Fisk, a fetal-medicine specialist at the University of Queensland in Brisbane, Australia.
And, Lyerly asks, what are the chances that surgery will damage a woman’s uterus, leaving her infertile? Surgeons attempting to fix spina bifida defects in the fetus don’t yet know, although a major trial will collect data on the physical and psychological health of the mother.
That’s a step in the right direction, says Lyerly, though she cautions: “Because these techniques are so high-tech and are the signature programs of well-known institutions, parents assume they are therapeutic. These interventions are experimental; parents must recognize the risks to the woman as well as to her fetus.”