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FlowerFetal Surgery
Programs that perform this procedure
 Ultrasound Division    Advanced Fetal Care Center  
 General Surgery Program  
What is fetal surgery?
Fetal surgery is the surgical treatment of a fetus with certain life-threatening congenital abnormalities. Surgical intervention during pregnancy on the fetus is meant to correct problems that would be too advanced to correct after birth. A wide range of surgical techniques can be used to treat the fetus. Generally, the techniques are divided into two categories:
Fetal surgery is the surgical treatment of a fetus with certain life-threatening congenital abnormalities. Surgical intervention during pregnancy on the fetus is meant to correct problems that would be too advanced to correct after birth. A wide range of surgical techniques can be used to treat the fetus. Generally, the techniques are divided into two categories:
  • Open fetal surgery: A hysterotomy (Cesarean section) is performed and the fetus is partially removed so that the area that needs surgery is exposed. After corrective surgery is performed, the fetus is returned and the uterus is closed. In some cases, surgery on the fetus is scheduled to coincide with delivery. Surgery would be done on the fetus after Cesarean section, but before the cord is cut, so that the fetus is sustained by the mother's placenta and doesn't have to breath on his or her own. This method, known as an EXIT (ex utero intrapartum treatment) is usually employed when the fetus suffers from a congenital defect that blocks the airway, such as a cervical teratoma. EXIT gives surgeons time to perform multiple procedures to secure the baby's airway, so that by the time the cord is cut and the baby has to breath, he or she has an unblocked airway.
  • Fetoscopic surgery: This type of surgery, which employs minimally invasive techniques, is used more often than open surgery. Surgeons can use fiberoptic telescopes and specially designed instruments to enter the uterus through small surgical openings to correct congenital malformations without major incisions or removing the fetus from the womb. This alternative is less traumatic and reduces the chances of preterm labor.
When is fetal surgery an option?
Fetal surgery becomes an option when doctors predict that the fetus will not live long enough to make it to delivery or live long after birth. For instance, if it is discovered on prenatal ultrasound that a fetus has a severe form of congenital diaphragmatic hernia, in which the liver is located in the chest and lung development is severely restricted, fetal therapy may alleviate the severity of the problem. This way, the baby has enough function to live upon delivery and undergo further corrective surgery.

Fetal tumors are another life-threatening condition that can be treated in utero. Often benign sacrococcygeal tumors early in development can grow very large and cause the baby's heart to work very hard to pump blood causing heart failure and possible death. Guided by ultrasound imagery, radiofrequency ablation can be used to cut off blood supply to the tumor. This maneuver hinders the tumor's growth so that the fetus can survive until it is delivered, and the tumor can be safety removed after birth.

Fetal surgery is now also being considered in the treatment of some severely disabling conditions that aren't life threatening, but could benefit from fetal intervention. For instance, research has found that if some types of spina bifida are caught early enough in gestation, a certain amount of spinal cord function can be preserved, which would dramatically alter the course of therapy for the better upon birth.

What are the risks associated with fetal surgery?
Before undergoing fetal surgery, you must understand and accept the risks associated with the procedure that your doctor has recommended. The biggest risks associated with open fetal surgery include bleeding, infection, preterm labor and more rarely, complications associated with anesthesia medications. After fetal surgery, both mother and fetus are monitored very closely in the hospital. Mothers will receive various medications to control pain, usually with an epidural, and will receive a variety of medications to control and prevent preterm labor.

Most of the open surgical techniques involve an incision in a part of the uterus that would require you to have any future children delivered via Cesarean section. Fetal surgery also poses risks to the health of the fetus, but these risks are usually outweighed by the benefit of surgery, since usually surgery is performed to save the fetus's life or to have an increased improvement in function. Be sure to discuss any risks of surgery to the mother and fetus fully with your doctor.

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