Foetal surgery is defined as a surgical procedure performed on a preborn baby prior to birth, also called prenatal surgery. It is done when a preborn baby is not expected to live long enough to make it through delivery or after birth without prenatal intervention.
Most pre-natal surgeries are performed between 18 and 26 weeks of gestation. Technical difficulties associated with the small size of the preborn baby and fragility of the tissues generally limit surgery before 18 weeks.
It has been shown that preborn babies feel pain from week 20, and therefore pain relief should be provided during in utero interventions from 20 weeks on.
For the purposes of surgery on preborn children, fetal anesthesia is routinely administered and is associated with a decrease in stress hormones compared to their level when painful stimuli are applied without such anesthesia.
The world’s first fetal surgery survivor met his doctor 10 years ago, at the age of 24. Medical history was made in 1981, when Michael Skinner was the first baby in the world to survive successful fetal surgery to repair a life-threatening condition while still in the womb. His mother, Rosa Skinner, was seven months pregnant at the time, and in her womb, Michael lay next to his twin sister, Mary. This case has led to treatments that have saved many lives since.
Late-term babies born alive
The threshold of viability is constantly changing, with medical advances enabling babies born prematurely to survive at earlier and earlier stages. The major factor in determining infant viability is gestational age. With increasing rates of prematurity and advancement in neonatal intensive care, more infants are surviving at gestational ages as low as 22–23 weeks in developed countries. This has resulted in a shift in the grey zone of viability to 22–25 weeks gestation in those countries.
Some reported cases of babies born prematurely and surviving include:
- Baby Frieda, born at 21 weeks and 5 days, weighing 455g.
- James Elgin Gill, born at 21 weeks and 5 days, weighing 624g.
- Amillia Taylor, born at 21 weeks and 6 days, weighing 280g.
- Stella Miloseski, born at 22 weeks and 5 days, weighing 440g.
- Baby Jacob, born at 24 weeks, weighing 735g.
- Rumaisa Rahman, born at nearly 26 weeks, weighing 261g.
- John Metaxiotis, born at 26 weeks, weighing 395g.