BME 273 Fetal Stabilizer for Intrauterine Surgery Michael Dinh Advisor: Dr. Joseph Bruner

Spina Bifida Spina Bifida affects approximately 1 out of every 1,000 newborns in the U.S Each year in the US about 4,000 pregnancies are affected by spina bifida and anencephaly, an average of 11 pregnancies per day Spina bifida is the most frequently occurring permanently disabling birth defect. It affects approximately one out of every 1,000 newborns in the United States. Spina bifida, the most common NTD, is one of the most devastating of all birth defects. It results from the failure of the spine to close properly during the first month of pregnancy. In severe cases, the spinal cord protrudes through the back and may be covered by skin or a thin membrane. Surgery to close a newborn's back is generally performed within 24 hours after birth to minimize the risk of infection and to preserve existing function in the spinal cord. Because of the paralysis resulting from the damage to the spinal cord, people born with spina bifida may need surgeries and other extensive medical care. The condition can also cause bowel and bladder complications. A large percentage of children born with spina bifida also have hydrocephalus, the accumulation of fluid in the brain. Hydrocephalus is controlled by a surgical procedure called "shunting" which relieves the fluid build up in the brain by redirecting it into the abdominal area. Most children born with spina bifida live well into adulthood as a result of today's sophisticated medical techniques.

Myelomeningocele Defect in the spinal column Protrusion of spinal cord membrane, spinal cord, and nerve roots Bathing of developing spinal cord with amniotic fluid results in progressive neurological injury Spina bifida carries an incidence in the United States of 1 to 2 per 1,000 births. This malformation appears to result from failure of the primitive neural tube to close during early embryogenesis, between 3 and 4 weeks gestation. Although these malformations can occur anywhere along the developing spine, most lesions are found in the lumbo-sacral region. Typically, spina bifida is characterized by herniation of the meninges (spinal cord membranes), spinal cord and nerve roots through a bony defect in the spinal column. Chronic bathing of the fragile developing spinal cord with amniotic fluid irritants over the course of gestation is thought to result in progressive neurologic injury. A spectrum of neurologic sequelae can be found depending upon the level of the defect, its size and content, and the presence of any associated anomalies, such as hydrocephalus, Chiari malformations or agenesis of the corpus callosum. Urinary dysfunction is nearly always present, bowel dysfunction is variable and orthopedic abnormalities (club foot) often occur below the level of the defect. Minor paresthesias, complete paraparesis and paraplegia can compromise these children further. Normal intellectual development is noted in over 70% of affected children, but is dependent upon the associated brain abnormalities as listed above.

Vanderbilt University 165 cases of spina bifida repair Age range of infants 19-30 weeks Mean operating time is about 87 min Ranges from 62-131 min Dr. Bruner Vanderbilt University

Design Objective Design a fetal stabilizer to assist in surgery Hold fetus steady while providing an opening for operation Dr. Bruner Vanderbilt University

Current and Future Outlook No known device that serves such function Design which leads to a prototype Feasible in size and not cumbersome in use