Austin doctors use procedure to save babies suffering from rare disorder

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by KVUE

khou.com

Posted on July 31, 2013 at 10:15 AM

AUSTIN, Texas -- It's never easy on an expectant mother when she learns her unborn child may already be fighting for its life due to a serious health problem.  Fetal bladder obstruction is so rare it affects only about one in four-thousand. Although a rare condition -- doctors say if it goes undetected -- it's almost always fatal.

Megan Guzman is 25-weeks pregnant.  While getting an ultrasound isn't out of the ordinary --  it is a necessity. Doctors need to monitor the health of her unborn son Eric Arthur. Just 10-weeks ago he was suffering from fetal bladder obstruction.  It's an extremely rare and often fatal condition if undetected.

"I was very scared and very terrified that he wasn't going to be able to make it, because there was a lot of risk in the procedure," said Guzman.

"In Megan's case when you looked at (her) little one's bladder it was super, super enlarged," said Sina Haeri, M.D., a maternal-fetal medicine specialist at St. David's Women's Center of Texas.  "It had backed up the urine up the kidneys."  

Haeri says fetal bladder obstruction becomes evident after about 15 weeks, or when the placenta stops producing amniotic fluid -- that's the water around the baby.

"After the placental production cuts off the baby is unable to empty out the urine," said Haeri.  "Eventually that water around the baby gets lesser and lesser and lesser.  That compression on the baby's chest causes the lungs not to develop.  That in turn leads to almost 100 percent mortality in the baby.  

Tests showed Guzman's baby's genes and kidneys were normal, so Haeri performed the in-utero bladder surgery.  He goes through the mother's and baby's abdomen to insert a shunt.

"We put a shunt or tube between the bladder and the amniotic cavity inside the uterus to bypass the blockage and let that fluid exit," said Haeri.  "It saves the kidneys and it provides a cushion for the baby's lungs to develop."

Haeri says the procedure is not risk free.

"There's always a chance of hitting a blood vessel, or hitting an organ," he said.  "The baby can often pass away from the procedure or have irreversible damage, but those are the risks that the couple takes to provide the benefit to the baby."

A risk Guzman and her husband were willing to take.  Now they eagerly await her October due date.

"I was just amazed," said Guzman.  "My grandmother is an RN (Registered Nurse.) She said she can't believe they were able to do everything so fast and do the testing here in one spot without going anywhere."

Haeri points out the in-utero bladder shunt surgery does not correct the problem. Rather, it bypasses the problem and allows the baby to grow normally inside the womb.  Once born, the baby will require bladder obstruction surgery to fix the problem once and for all.

 

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