What is fetal surgery?
Fetal surgery covers a range of techniques and procedures used to treat birth defects in fetuses. It is a growing area of medicine that aims to treat cases where the condition may be very advanced by the time the baby is born.
Why is it performed?
In the past fetal surgery was intended only in cases where the fetus had a life-threatening condition. These could include:
- Tumors in which the heart and cardiovascular system were in danger.
- Sacrococcygeal teratoma, a tumor that grows on the coccyx and can deprive the fetus of essential nutrients.
- Congenital diaphragmatic hernia, a congenital defect that prevents the development of the lungs.
- Twin-to-twin transfusion syndrome, a condition with a high mortality rate in which one of the twins does not receive enough blood from the shared placenta
- Urinary tract obstruction
Fetal surgery covers a number of techniques and procedures used to treat birth defects in fetuses.
However, fetal surgery is now used to treat a number of non-life-threatening conditions. These are the conclusion of a growing body of research comparing the outcomes of children who have had surgery before with those who had surgery after birth. For some conditions, receiving surgery before birth has dramatically reduced the risk of physical or mental deterioration and has led to a much better quality of life.
The prime example is spina bifida, in which the spine does not close completely, causing the spinal cord and fluid to leak. Without treatment, this condition can lead to lifelong paralysis and spinal problems.
What does this surgery involve?
There are three types of fetal surgery:
- Open fetal surgery: which involves cutting into the abdomen and uterus (hysterotomy) to operate on the fetus. This technique carries a great risk to the mother and baby, so it is now avoided when less invasive options are available.
- Fetoscopic surgery: a form of minimally invasive surgery that involves inserting a fiberoptic endoscope into the uterus and then using a series of specialized tools to operate on the fetus. In some cases fetoscopic surgery can be performed under local anesthesia.
- The EXIT procedure which consists of performing a cesarean section, but keeping the baby together with the umbilical cord and placenta during the surgery.
Finally, since fetal surgery can often cause the uterus to contract, tocolytics are usually administered to prevent labor.
Fetal surgery carries risks for both mother and child, including infection, bleeding and complications from the use of anesthesia. Your doctor will discuss the risks with you before recommending any procedure and will give you the opportunity to change your mind at any time. However, fetal surgery techniques continue to improve and are likely to be adopted for the treatment of other birth defects in the future.