Fetal Surgery

Fetal surgery is the surgical treatment of a fetus with certain life-threatening congenital abnormalities. Surgical intervention on the fetus is meant to correct problems that would be too advanced to correct after the baby is born.

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 we perform corrective surgery, the fetus is returned and the uterus is closed.

In some cases, surgery on the fetus is scheduled to coincide with delivery. Surgery is done on the baby 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 breathe on his own.

This method, known as an EXIT (ex utero intrapartum treatment), is usually used 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 your baby's airway, so that by the time the cord is cut and your baby has to breathe, he 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 fiber-optic 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 if your doctors predict that the fetus will not live long enough to make it to delivery or live long after birth.

• Congenital diaphragmatic hernia (CDH): If doctors discover 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, your baby has enough function to live upon delivery and undergo further corrective surgery.
• Fetal tumors: a life-threatening condition that can be treated in utero. Often, benign sacrococcygeal tumors early in development can grow very large and cause your baby's heart to work too hard to pump blood, causing heart failure and possible death. Guided by ultrasound imagery, your doctors can 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.

What are the risks associated with fetal surgery?

Before undergoing fetal surgery, you should understand and accept the risks associated with the procedure that your doctor has recommended.

The biggest risks of open fetal surgery include:

• bleeding
• infection
• preterm labor
• complications associated with anesthesia medications (rare)

After fetal surgery, both mother and fetus are monitored closely in the hospital. Mothers receive various medications to control pain, usually with an epidural, and 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 mothers 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' life or to have an increased improvement in function.

Be sure to discuss any risks of surgery fully with your doctor.

A comprehensive level of care

The Maternal Fetal Care Center (MFCC) at Boston Children's is making a significant difference in the outcomes for families facing complex birth defects and other critical challenges to the health of their fetus or newborn.

Pushing beyond the pages of yesterday's textbooks, we are rewriting what is possible in fetal medicine delivering hope — and healthy babies — through groundbreaking advancements and a commitment to the best in pediatric care.