- Associated Press - Wednesday, February 9, 2011

LOS ANGELES (AP) - Pregnant women were afraid to have it. Doctors were afraid to do it. Hospitals stopped performing the surgery because the government wanted evidence it was safe and worth doing.

Now, a landmark study shows that an operation to fix a hole in the spine while the fetus is still in the womb leads to better outcomes for children with spina bifida. The operation showed such a clear benefit over waiting until the infant is born that the study was stopped early.

“This is the first hope for spina bifida fetuses,” said lead researcher Dr. Scott Adzick of Children’s Hospital of Philadelphia, one of three places that participated in the study.

Doctors started experimenting with fetal surgery for spina bifida in the mid-1990s, cutting into the mother’s abdomen and uterus to close the gap in the spine. It even became part of the abortion debate when a photo of a tiny hand poking out of a womb during surgery was published.

The government-funded study showed that babies who have the operation in the womb were more likely to walk without help and less likely to need a tube to drain fluid buildup in the brain. Fetal surgery did come with some risks, however, including a higher chance of being born premature and complications for the mother.

Spina bifida _ which means split spine _ happens when the spine doesn’t develop properly. In the most severe cases, the spinal cord sticks out through an opening in the spine. Children often are paralyzed or have weakness below the waist and many need crutches or a wheelchair. They also suffer from incontinence and fluid buildup in the brain.

Cases in the U.S. have dropped to 1,500 a year since 1998, when the government ordered that foods like cereals, breads and pasta be fortified with folic acid, which reduces the risk of the spinal defect.

Though spina bifida is usually diagnosed before birth, the operation is typically done days after delivery. Quick surgery can prevent further harm but cannot reverse the nerve damage that has already occurred.

When fetal surgery for spina bifida was first tried, it was controversial because operations in the womb were typically done for life-threatening problems. There was also no long-term research on the safety of the surgery. The operation even got caught up in the abortion debate when abortion opponents seized on a photo taken during surgery on a 21-week-old fetus at Vanderbilt University.

By the end of 2002, more than 230 spina bifida operations had been done, but some doctors remained skeptical. So the National Institutes of Health launched a big study that year at Vanderbilt, the Philadelphia hospital and the University of California, San Francisco. Other hospitals agreed not to do the surgery while the research was under way.

The researchers, whose findings were published online Wednesday in the New England Journal of Medicine, studied 158 babies who had the surgery either in the womb or after delivery. The fetal surgery was done between 19 and 25 weeks of gestation.

By the time they turned a year old, 40 percent in the fetal surgery group needed a drainage tube, or shunt, in the brain, compared with 82 percent in the standard surgery group. The fetal surgery group scored higher on combined tests of mental development and motor skills at 2 1/2 years, though there was no difference in cognitive function alone.

Forty-two percent of the toddlers in the fetal surgery group could walk without crutches or other support versus 21 percent in the other group.

Two children died within days of the fetal surgery; two children who had the fix after birth and had shunts died later.

Eighty percent of those who had fetal surgery were born premature compared with 15 percent in the after-delivery group. On average, children who had surgery while still in the womb were born 1 1/2 months early and had more breathing problems. A third of the mothers who had the operation had thinning in the wall of their uterus, a complication that requires cesarean delivery in the future.

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