5 Things You May Not Know About Fetal Surgery

Treatment for a high-risk pregnancy can range from close monitoring and regular checkups to more specialized interventions, including medication. In the most severe situations, your maternal-fetal medicine provider may recommend fetal surgery.

Let’s take a closer look at fetal surgery, what it is and how commonly it’s used. We’ll then highlight five things you might not know about fetal surgery, including the different types, what may make you and your baby a candidate and the risks and benefits associated with this highly specialized intervention.

What Is Fetal Surgery? 

Fetal surgery is any procedure where a surgeon operates on a fetus while it is still in the mother’s uterus. The term covers various surgical techniques to treat congenital abnormalities before a baby is born. Other terms for fetal surgery include:

• In-utero surgery
• Prenatal surgery
• Fetal intervention (for less invasive procedures)

Fetal surgeries are used for severe conditions the baby may not survive until birth or conditions that can cause significant damage or development problems if they are not corrected before delivery. 

How Common Is Fetal Surgery? 

Fetal surgery is relatively rare because of its complexity and the limited number of conditions it aims to treat. It’s also highly specialized, and few centers in North America have the expertise and technology to perform fetal surgery. However, the field is gradually expanding with advances in technology, medical knowledge and surgical techniques. 

According to the Association of American Medical Colleges (AAMC), “In 2005, the North American Fetal Therapy Network (NAFTNet) — which provides support to fetal centers, promotes cooperation between them and fosters related research — launched with just seven member institutions. Today it counts 46, many at academic medical centers.”

5 Things You May Not Know About Fetal Surgery

If you find yourself in a position where you’re discussing fetal surgery, you probably have a lot of questions. The best resource, of course, is your care team. But we’ve put together this list to get you started.  

1. Fetal surgery is different from neonatal surgery. 

The term neonatal surgery refers to a procedure that happens after a baby is born. Fetal surgery is unique because the procedure is performed while the baby is still in the womb, often at a gestational age where it would not be viable outside the uterus.

2. The first successful open fetal surgery was performed over 40 years ago. 

Dr. Michael Harrison performed the first successful fetal surgery in 1981 when he operated on a fetus with a urinary tract blockage (obstructive uropathy). The surgery involved inserting a catheter into the fetus’s bladder to allow urine to drain properly. The baby was born a month early, along with his twin sister. Both survived. 

3. Fetal surgery keeps getting better. 

Dr. Harrison’s breakthrough surgery showed that it was possible and could improve outcomes for fetuses with certain conditions that develop in the womb. Today, thanks to advances in medical technology, many fetal surgeries are less invasive and more successful. Fetuses that undergo surgical intervention have an 80% to 90% survival rate today, according to the AAMC. That number was 60% just 15 years ago. 

4. Fetal surgery is used to treat specific conditions. 

Given its complexity, fetal surgery comes with a high risk for the fetus as well as risks for the mother. Because of this, fetal surgery is only used to treat specific life-threatening conditions or those that could cause serious long-term problems if left untreated. Some of these conditions include: 

• Spina bifida
• Twin-to-twin transfusion syndrome (TTTS)
• Congenital diaphragmatic hernia

5. There are different types of fetal surgery. 

The following are categories of fetal surgery: 

• Ultrasound-guided fetal interventions. These are procedures conducted under ultrasound guidance to treat fetal conditions in utero. They are less invasive than open surgery procedures. Some of the conditions treated include: fetal hydrothorax, congenital pulmonary airway malformation (CPAM), bladder outlet obstruction (BOO) and twin reversed arterial perfusion sequence (TRAP).
• Open fetal surgery. This direct surgical procedure on the fetus inside the womb requires a surgical incision in the mother’s abdomen and uterus. Some conditions treated with open fetal surgery include: Spina bifida, fetal tumor and congenital pulmonary airway malformation (CPAM). 
• Fetoscopic surgery. This involves using a long, thin tube equipped with a tiny camera and light (fetoscope) that allows surgeons to perform procedures without making a large uterine incision. Conditions treated with fetoscopic surgery can include TTTS, cord entanglement in twins and amniotic band syndrome (ABS).
• Ex-Utero Intrapartum Treatment (EXIT Procedures). EXIT procedures are performed at the time of delivery, where the fetus is partially delivered and still on placental support. EXIT procedures are sometimes used when a baby has developed a neck or chest mass, causing the airway to be compressed.

The type and timing of fetal surgery are dependent upon the severity of the condition, the gestational age of the fetus, the overall health and well-being of the mother and the potential risks and benefits of the procedure.

How Long Does Fetal Surgery Take? 

How many hours you and your baby are in surgery depends on the type of surgery and the specific condition being treated. EXIT procedures and fetoscopic surgeries can take between two and three hours, while more complex and invasive procedures may take longer. 

Recovery time also varies. In the case of open fetal surgery to correct spina bifida, for example, the mother may be cared for in a high-dependency setting for up to 48 hours and remain in the hospital for five to seven days after surgery. For less invasive procedures, patients may be discharged after one day in the hospital. 

Risks Involved in Fetal Surgery

Fetal surgery poses risks for both mother and baby. Even less invasive fetal interventions can come with risks, such as inducing preterm labor. Additional risks for the mother include infection, bleeding, blood clots, placental abruption and uterine damage.

While survival rates for fetuses have increased significantly, there is always a risk of fetal death when performing an intrauterine procedure. Even if the surgery goes as planned, it does not guarantee a complete cure. Often, though, fetal surgery significantly improves the baby’s prognosis and quality of life.

The choice of whether to undergo fetal surgery is multifaceted and difficult for any parent. It’s important to understand all the risks and work with your entire care team to weigh them against potential benefits.