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MOMS, fetal surgery, fetal-surgery, spina bifida, spinabifida, fetal,NTD,
neural tube defect, myelomeningocele,AFP,alpha fetoprotein,
MOMS is a research study designed to compare two approaches to the
treatment of babies with spina bifida: surgery before birth (prenatal or
fetal surgery) and surgery after birth (postnatal surgery). Spina bifida
is a complex birth defect in which a portion of the spinal cord and
associated nerves as well as the surrounding spinal bones and overlying
muscle and skin do not fully develop. At birth the incompletely developed
portion of the spinal cord protrudes through the open bones and skin.
The incomplete development of the spinal cord can occur anywhere
along its length, from the neck to the lower back and results in a
variety of medical problems.
One of the most common and important conditions associated with spina bifida occurs because the brain is positioned further down into the upper part of the spinal canal (neck area) than it should be. This abnormal positioning of the brain is part of what makes up a condition called the Arnold Chiari II malformation. This malformation leads to blockage of the normal flow of spinal fluid causing it to collect in the fluid cavities brain (ventricles). The condition of over- filled ventricles is called hydrocephalus.
Since the 1930's, the first step in the treatment of babies with this condition has been to surgically close the opening in their back within a few days of birth. The surgery puts the tissues back in their normal position and prevents further damage to and infection of the nervous tissue, but DOES NOT restore function to the already damaged nerves. The second step is usually placement of a thin tube called a shunt within the ventricles which allows for drainage of the excess fluid and relieves undue pressure on the brain. A shunt usually passes under the skin from the head into the abdomen.
Over the years, doctors have noticed that nerve function in babies with spina bifida seems to worsen throughout pregnancy. Often movement in the legs and feet which can be seen by sonogram early on is not seen later in the pregnancy. This suggests that there is ongoing damage to the open portion of the spinal cord, possibly from contact with amniotic fluid. In addition, both animal and human studies have shown that the ability of the body to repair damaged nervous tissue is best in young individuals. Because of these considerations, doctors have been working on ways to close spina bifida defects as early as possible.
In 1994 doctors began trying out various methods for closing spina bifida defects while the baby is still in the mother's womb. Since that time, many improvements have been made in the procedure. It is still not known, however, whether it is better to operate on a baby with spina bifida before or after it is born. MOMS is designed to answer that question. The National Institute of Child Health and Human Development (NICHD), a part of The National Institutes of Health (NIH), has funded this study to compare how babies who have prenatal surgery do compared to those who have postnatal surgery. There are three participating MOMS Centers: the University of California at San Francisco in San Francisco, California, The Children's Hospital of Philadelphia in Philadelphia, Pennsylvania and Vanderbilt University Medical Center in Nashville, Tennessee. The study will be coordinated by the Biostatistics Center of the George Washington University in Rockville, Maryland. The goal is to find out if either treatment is better for the baby.