UHealth Jackson Fetal Care Team Offers In-utero Surgery for Rare Conditions

Fetal surgery is a highly specialized and complex field of medicine that offers surgical interventions to repair or treat birth defects in the womb.

While these types of conditions are rare, the fetal care team at UHealth Jackson Fetal Care offers a wide range of in-utero therapies. They also provide specialized care and planning for the delivery of babies with complex conditions that did not undergo in-utero surgery.

We spoke with Rodrigo Ruano, MD, PhD, director of the UHealth Jackson Fetal Care Center and division chief of UHealth Jackson Maternal-Fetal Medicine, to learn more about fetal surgery and the specialized care his team offers unborn babies and their mothers.

Q: While you operate on fetuses with rare conditions, what are the most common procedures you perform?

A: We can operate to fix several complex issues or diseases, but some of the most common procedures we perform are:

• Fetoscopic laser ablation to treat twin-to-twin transfusion syndrome, which is when identical twins share a placenta and blood is dispersed in unbalanced ways between the two, causing several serious conditions for both babies.
• In-utero repair of fetal spina bifida, which is a condition where the spine does not develop correctly. It can lead to issues, including water in the brain and Chiari malformation, where parts of the brain are pushed down in the spine due to limited room.
• Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia, which is when there is a hole in the diaphragm that allows organs from the abdominal cavity to move up, leaving little space for the lungs to fully develop.
• Fetal cystoscopy for fetal bladder obstruction, which usually occurs in males. If left untreated, this can lead to problems with the lungs and end-stage renal disease that requires dialysis or a transplant.
• Surgical removal of tumors in the lungs or spine.
• Blood transfusions for fetuses found to be anemic.

Q: How has fetal surgery changed in recent years?

A: General improvements in medicine, tools, and technology have helped us perform more complicated procedures.

With the advancement of ultrasounds, MRIs, and echocardiograms, we can diagnose and treat patients much faster. These resources allow us to have a clearer picture of the anatomy, so we can better plan and prepare for surgery. There are also more telescopes and tools specifically designed for in-utero procedures, which are incredibly helpful when operating on small fetuses.

Q: What inspired you to pursue a career in this highly specialized area of medicine?

A: I didn’t plan to specialize in fetal surgery. In a way, it found me. After earning my medical degree in Brazil, where I’m from, I trained in Europe with a doctor who performed fetal surgery, exposing me to this new area of medicine.

When I returned to Brazil, there weren’t any doctors performing fetal surgery. Because of my experience and exposure to it, I was asked about offering my services to patients. Now, I can’t imagine doing anything else.

Q: What is the recovery and delivery like after fetal surgery?

A: In some cases, fetal surgery can be done using tiny scopes, needles, and minimally invasive techniques, so we can avoid the need to surgically open the uterus. In those situations, patients can go home within a few days, as long as the fetus and mom are doing well, and can then deliver vaginally when the time comes.

In more severe cases, when the uterus must be opened to enable the surgery or there is a very complex case, patients may still be discharged days after the procedure, but require a Cesarean section when it is time to deliver.

In all cases – even when monitoring patients who didn’t have fetal surgery but are carrying a fetus with a complex condition – we help plan and coordinate the delivery with a specialized maternal-fetal care team to ensure the best care for both mom and baby.

Post-natal care is also critical to ensuring the best outcomes. That’s why choosing a hospital with access to various pediatric specialties, great neonatal intensive care, and a maternal-fetal care team is critical. At Jackson, we have experts in cardiology, nephrology, neurology, neonatal care, and much more. We all collaborate to offer a comprehensive, multidisciplinary approach.

Q: What do you love most about your job?

A: I love getting to see the babies and families that I’ve helped. We have had some miracle babies that had very complex cases who surprised us with how well they are doing.

Most of the families keep in touch, and some send me photos and updates. Recently, one of the families I helped was in Florida on vacation, and they stopped by to see me. It means so much to me that I can help them through a difficult time in their lives. That is my joy. It’s what inspires me every day.