Intrauterine Fetal Surgery

Fetal surgery also known as fetal reconstructive surgery,[1] antenatal surgeryprenatal surgery,[2] is a growing branch of maternal-fetal medicine that covers any of a broad range of surgical techniques that are used to treat birth defects in fetuses who are still in the pregnant uterus. There are three main types:[3] open fetal surgery, which involves completely opening the uterus to operate on the fetus; minimally invasive fetoscopic surgery, which uses small incisions and is guided by fetoscopy and sonography; and percutaneous fetal therapy, which involves placing a catheter under continuous ultrasound guidance.

Fetal intervention is relatively new. Advancing technologies allow earlier and more accurate diagnosis of diseases and congenital problems in a fetus.

Fetal surgery draws principally from the fields of surgeryobstetrics and gynecology, and pediatrics– especially the subspecialties of neonatology (care of newborns, especially high-risk ones), maternal-fetal medicine (care of high-risk pregnancies), and pediatric surgery. It often involves training in obstetrics, pediatrics, and mastery of both invasive and non-invasive surgery, meaning it takes several years of residency, and at least one fellowship (usually more than one year), to be able to become proficient. It is possible in the U.S. to become trained in this approach whether one started in obstetrics, pediatrics, or surgery. Because of the very high risk and high complexity of these cases, they are usually performed at Level I trauma centers in large cities at academic medical centers,- offering the full spectrum of maternal and newborn care, including a high level neonatal intensive care unit (level IV is the highest) and suitable operating theaters and equipment, and a high number of surgeons and physicians, nurse specialists, therapists, and a social work and counseling team. The cases can be referred from multiple levels of hospitals from many miles, sometimes across state and provincial lines. In continents other than North America and Europe, these centers are not as numerous, though the techniques are spreading.

Most problems do not require or are not treatable through fetal intervention. The exceptions are anatomical problems for which correction in utero is feasible and may be of significant benefit in the future development and survival of the fetus. Early correction (prior to birth) of these problems will likely increase the odds of a healthy and relatively normal baby.

The pregnant woman bears as much, if not more, risk as her fetus during any form of fetal intervention. Besides the general risk that any surgery bears, there is also a risk to the health of the mother’s uterus, potentially limiting her ability to bear more children.[citation needed] The risk is higher than from an elective Cesarean section because:

  • the incision typically will be a classical vertical one, with a greater risk of complications in subsequent pregnancies
  • the longer duration of the surgery, while the fetal intervention is performed
  • delivery of the baby will require a second Cesarean section days or weeks later


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