Doctors and medical support staff perform surgery at Latifa Women and Children's Hospital in Dubai.
A first-ever in the 22-country Arab World, a baby boy, expected to be born approximately after 34 weeks, but diagnosed with the severest form of spinal cord defect called Myelomeningicole, has been given the opportunity to live normally, by a group of 20 highly-trained doctors and medical support staff of the Latifa Women and Children’s Hospital and Rashid Hospital in Dubai.
The 24-year-old Emirati mother, F.A., is “stable, doing well and out of the ICU (intensive care unit),” according to Latifa Women and Children’s Hospital chief executive officer/Obstetrics-Gynaecology consultant Dr Muna AbdulRazzak Tahlak.
From the press conference at the Dubai Health Authority (DHA) headquarters on Sunday that announced the medical breakthrough labelled as “the first-ever intrauterine foetal surgery in the Arab Region,” DHA Director General Humaid Al Qutami said: “The DHA dedicates this great achievement to the wise leadership of the UAE who always direct us to implement everything that achieves security, health and safety of community members."
Al Qutami was grateful for the unwavering support of and inspiration from the leadership for the pursuit of quality life.
Humaid Al Qutami poses with the doctors and other officials.
The “extra delicate” surgery performed on the mother and her unborn child, the third in the family, was performed last week. While Tahlak handled what had to be done on the mother, it was Rashid Hospital-Functional Neurosurgery specialist/Paediatrics neurosurgeon Dr. Mohammed Sultan Al Olama who took care of the operation on the foetus.
Tahlak said Arnold Palmer Hospital for Children (Florida) Paediatric neurosurgeon Dr Samer ElBabaa and Orlando Health Winnie Palmer Hospital (Florida) Maternal and Fetal Medicine specialist Dr Cole Douglas Greves flew in for the historic Arab World surgery. She acknowledged that these two US-based experts have been instrumental for the development of a UAE-based team for such medical conditions. She was grateful for the efforts of the DHA leadership and management in continually providing avenues by which its medical plantilla would improve on their respective fields.
Details of the case disclosed that the unborn baby born was detected to be suffering from Spina Bifida and specifically Myelomeningicole through an ultrasound performed on his mother at the pre-natal check-up at 24 weeks.
Doctors perform the surgery.
Spina Bifida, the severest of which is Myelomeningicole, occurs in one every 1,000 pregnancies. It is a neural tube abnormality that occurs at the first month of pregnancy. The spinal cord fails to develop and close properly. With Myelomeningicole, a portion or section of the spinal cord and nerves remains in a sac that protrudes at the lower back portion of the foetus. When undetected or ignored, it results in poor to inability to walk, bladder and bowel control problems, and hydrocephalus, among others.
Tahlak said Spina Bifida is caused by the lack of folic acid: “That is why we encourage women to not only take folic acid during pregnancy but even before.”
Al Olama said “not more than 250” intrafetal Spina Bifida surgery have been done worldwide since the 1990s. Only 12 countries have the capability and capacity to perform this.
The condition of the mother-and-child was referred to Tahlak. Another set of tests that included an ultrasound, fetal echocardiogram and fetal Magnetic Resonance Imaging was completed “to understand the type and depth of the lesion and to completely evaluate the case to determine whether the patient is eligible for the intrauterine procedure.”
“The doctors have to be honest with the patient (as the patient must be honest with the doctors),” said Tahlak as she explained that after all the diagnostics and analyses, the would-be parents went through a series “and lots of” of counseling for them to fully understand as well as embrace the situation and the medical solution.
Tahlak recalled the mother as saying: “I want him to be a healthy boy and lead a healthy and happy life. As complicated and as difficult the procedure was, I never hesitated even for a second coming to Latifa Hospital.”
Tahlak said a Caesarian section was performed on the mother, particular from the back of the womb or uterus and consequently, the foetus “was positioned in a way that the lesion was facing the incision so that Dr. Mohammad Sultan Al Olama could correct the spinal cord defect; as both mother-and-child were being monitored with regular fetal heart rate monitoring.”
Al Olama, the Emirates Society of Neurological Surgeons president, said he began “repairing under the microscope the spinal cord defect” after injecting anaesthesia on the foetus. The procedure that “removed the extra sac, and preserved the spinal cord and the nerves” took 50 minutes.
Tahlak gently filled up the womb thereafter with a special solution of antibiotics and saline according to the amount lost during the procedure: “We closed the uterus again and tightly sealed it to prevent any leak of amniotic fluid.”
Tahlak and Al Olama said the family is constantly being monitored and counseled. This would continue even in the growing up years of the born expected to be delivered approximately after 34 weeks.
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