Dr Mandeep Singh, a renowned fetal medicine expert with family roots in Mumbai, performed a complex surgery to repair the spinal defect in a baby of 24 weeks gestation
An Indian-origin doctor in the UAE has created history by successfully performing a potentially life-changing in-utero procedure on a pregnant patient from South America. Dr Mandeep Singh, a renowned fetal medicine expert with family roots in Mumbai, led a team of doctors in performing the highly complex surgery at a hospital in Abu Dhabi, making him the first Indian-origin doctor to perform such a surgery.
The patient from Colombia underwent the rare open spina bifida procedure at Abu Dhabi-based Burjeel Medical City’s Kypros Nicolaides Fetal Medicine and Therapy Center in the hopes of preventing short-term and long-term complications for her baby. Dr Singh, Consultant, Fetal Medicine and Obstetrics, and CEO of Burjeel Farha (division of women and children) at Burjeel Medical City, performed in-utero fetal surgery to repair the spinal defect in a baby of 24 weeks gestation. He is one of the few surgeons in the world trained to perform in-utero spina bifida repair. Dr Singh has trained under Prof. Kypros Nicolaides, who is regarded as the ‘Father of Fetal Medicine’ and has worked as Consultant in Fetal Medicine at Fetal Medicine & Research Institute, King’s College Hospital, Denmark Hill, London.
Spina bifida is a birth defect that happens when the bones of the spine do not form and this leads to the spinal cord being left exposed to amniotic fluid, resulting in permanent disability. The condition can often lead to permanent loss of bowel and urinary bladder control, paralysis, or weakness of both lower limb muscles. The in-utero repair is performed between 19-25 weeks of gestation to close the defect in the spine, thereby offering improved outcomes. The average worldwide incidence of spina bifida is one per 1,000 births.
Dr Singh led a six-member medical team to conduct the highly advanced procedure at the Kypros Nicolaides Fetal Medicine and Therapy Center at Burjeel Medical City, which is a leader in high-risk maternity and delivery care.
According to Dr Singh, who has trained and worked in the UK for 22 years, during the fetal repair surgery, a small incision is made on the uterus and the back of the baby is exposed to allow the neurosurgeon to close the spina bifida defect.
“We use a synthetic patch to cover the defect. The amniotic fluid is then instilled back into the cavity and the uterus is closed back up. The baby will remain in the womb for the remainder of the pregnancy and will be delivered by caesarean section at 37 weeks’ gestation,” the doctor said.
The mother is stable and expected to deliver her baby at the Abu Dhabi hospital in August. After the birth, a specialist team of neonatologists, pediatric urologists, and a pediatric orthopedic, and rehabilitation team will review the baby and plan its care.
In-utero spina bifida repair is not readily available everywhere and there are only approximately 14 centers that perform this complex procedure worldwide. Couples from Asia and South America usually travel to the USA and Europe to seek medical care for the condition. But it is a costly procedure, according to the families.
“We were shocked after our routine 20-week scan showed that our baby’s spinal cord was not forming correctly. The option of ending the pregnancy was also discussed with us but we believe in miracles and that life is a gift of God. Our doctor suggested that our best course of action was to undergo spina bifida repair before the baby was born,” said Liz Valentina Parra Rodriguez and Jason Mateo Moreno Gutierrez, the Colombian couple who travelled to Abu Dhabi for the procedure to give their baby the best chance possible.
According to Dr Singh, the procedure is not a cure, but it could make a big difference in the child’s life after birth. “In-utero repair of spina bifida reduces motor function loss of limbs and improves outcomes. After the delivery, the baby needs follow up and, in some cases, may need to undergo physiotherapy and other medical assessments to ensure their well-being,” Dr Singh said.
If untreated, depending on the severity of the condition, a baby born with spina bifida is at risk of developing a host of complications ranging from loss of power in leg muscles to issues with bowel and bladder control.
Despite its risks, early intervention through fetal surgery is said to improve outcomes in babies. “In-utero spina bifida repair is a cutting-edge treatment that has the potential to greatly improve outcomes in babies. I am hopeful that collaborating with institutes and specialists in India, we can increase accessibility to such advanced treatments in the country, eliminating the need to travel abroad,” said Dr Singh, who has performed several fetal surgeries till date.
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