Fetal Surgery Procedure

Overview

Specialized teams use fetal surgery techniques to treat health problems in babies before birth. The main goal is to help a fetus who has a birth defect or medical condition that could harm development or survival. These surgeries take place while the baby is still inside the uterus, and teams with special training and experience perform them. Common procedures and their main uses include:

Surgery Type	Primary Purpose
Open fetal surgery	Direct access for large repairs or tumor removal
Fetoscopic surgery / minimally invasive surgery	Smaller incisions, uses a camera (fetoscopy) to guide tools
Fetal therapy/intervention	General term for in-utero treatments

Fetal surgery is most often performed at specialized maternal-fetal centers that include surgeons, neonatologists, anesthesiologists, genetic counselors, and imaging specialists working as one team. The goal is to treat the fetus while preserving maternal safety.

Birth Defects and Conditions Treated

Fetal interventions address a variety of conditions, including:

• Spina bifida
• Twin-to-twin transfusion syndrome (TTTS)
• Twin anemia-polycythemia sequence (TAPS)
• Twin reversed arterial perfusion sequence (TRAP)
• Bladder outlet obstruction (BOO)
• Sacrococcygeal teratoma (SCT) or mediastinal teratoma
• Congenital cystic adenomatoid malformation (CCAM) or pulmonary sequestration
• Abnormal amniotic fluid levels, such as polyhydramnios (too much fluid) or oligohydramnios (too little fluid)
• Fetal anemia
• Congenital diaphragmatic hernia (CDH), fetal neck masses, or congenital high airway obstruction syndrome (CHAOS)

Some surgeries are life-saving, while others aim to reduce future disability or the need for complex care after birth. Not every fetal condition qualifies for surgery—timing, fetal development, and maternal health must all be considered.

Common Techniques

• Open Fetal Surgery: Surgeons make an incision in both the mother’s abdomen and uterus to operate directly on the fetus. Teams use this for larger repairs like spina bifida or SCT removal.
• Fetoscopic/Minimally Invasive Fetal Surgery: Surgeons use small tools and a camera (fetoscope) inserted through tiny cuts in the abdomen. This lowers risks and speeds recovery. Examples include fetoscopic laser ablation for TTTS and shunt placements for fluid or bladder problems.
• Fetoscopic Laser Ablation: Surgeons use this to close abnormal blood connections in the placenta for conditions such as TTTS or TAPS in twins.
• Fetal Endoscopic Tracheal Occlusion (FETO): Teams use this for severe lung and diaphragm conditions, placing a balloon in the fetus’s airway to help lung growth.
• Shunt Insertions and Fetal Cystoscopy: Surgeons use these to drain fluid or relieve blockages inside the fetus.
• Radiofrequency Ablation and Bipolar Cord Coagulation: Teams use these to treat certain tumors or abnormal blood vessel connections.
• EXIT (Ex Utero Intrapartum Treatment): Doctors work on the baby’s airway while still connected to the placenta during delivery.
• Intrauterine Transfusion or Amniotic Infusions: Teams use these for fetal anemia or to provide fluid in kidney or urinary tract issues.

Newer methods continue to emerge, with some centers offering fetal cardiac interventions for selected heart defects.

Reasons for This Procedure

Fetal surgery addresses serious health conditions discovered before birth, aiming to impFetal surgery addresses serious health conditions discovered before birth, aiming to improve the baby’s future health.

Common Reasons

• Spina bifida
• Congenital diaphragmatic hernia
• Gastroschisis
• Heart defects
• Twin-twin transfusion syndrome
• Amniotic band syndrome
• Congenital high airway obstruction syndrome (CHAOS)

Doctors may recommend surgery when there is a strong risk of death, severe disability, or irreversible damage if the condition is left untreated until birth. Each case is evaluated through advanced imaging, genetic testing, and multidisciplinary review before offering fetal intervention.

Possible Complications

FFetal surgery presents several risks for both the mother and the unborn baby. These risks include:

• Uterine rupture after open surgery (hysterotomy)
• Early labor or premature birth
• Fetal distress or death
• Blood loss or infection during the procedure
• Breathing or circulation problems requiring neonatal intensive care
• Need for cesarean delivery in current and future pregnancies

Because open fetal surgery creates a uterine scar, many patients must deliver by C-section and avoid labor in future pregnancies to lower the risk of rupture. Care teams monitor fetal heart rate and uterine activity before, during, and after the procedure to reduce these risks.

How to Prepare

Patients must undergo extensive evaluation, including detailed ultrasounds, fetal MRI, echocardiogram, and genetic screening. Counseling with maternal-fetal medicine, neonatology, and pediatric surgery specialists is required to understand the risks and goals.

Before Surgery

• Stop eating and drinking as advised by the team
• Discuss current medications and follow instructions on which to stop
• Arrange for post-op support and transportation
• Prepare for a possible hospital stay and follow-up visits

Some procedures are scheduled between 18–26 weeks of gestation, depending on the condition being treated.

What to Expect During Surgery

Surgery typically occurs in a high-level maternal-fetal center with access to a neonatal intensive care unit (NICU). The patient receives general anesthesia or spinal-epidural anesthesia, depending on the procedure.

• The fetus is monitored throughout
• The uterus is opened (for open procedures) or accessed via ports (for fetoscopy)
• Surgery is performed with great precision using magnified imaging
• The uterus is closed carefully to preserve pregnancy

For fetoscopic surgeries, local anesthesia and conscious sedation may be used to reduce maternal risk. Most patients remain hospitalized for observation and fetal monitoring after the procedure.

Recovery and Monitoring

• Patients often remain in the hospital for 1 to 5 days
• Activity may be restricted for several weeks
• Follow-up includes ultrasounds, fetal heart monitoring, and visits with maternal-fetal specialists
• Some may receive medications to prevent early labor
• Repeat imaging tracks the fetus’s progress until birth

Careful monitoring is critical, as preterm delivery remains a significant risk even after a successful procedure.

Outcomes

Trained teams performing fetal surgery achieve improved results for several conditions. Babies treated for spina bifida, for example, often have:

• Fewer disabilities
• Improved mobility
• Reduced need for shunts to treat brain fluid buildup (hydrocephalus)

Other outcomes:

Condition Treated	Surgical Impact
TTTS (laser ablation)	Increased twin survival, reduced complications
Pulmonary sequestration, CCAM	Lung mass reduction, better breathing at birth
Sacrococcygeal teratoma	Reduced heart failure risk from vascular tumors
Fetal anemia (intrauterine transfusion)	Increased survival, normal development
Congenital diaphragmatic hernia (FETO)	Improved lung growth and neonatal respiratory outcomes

In most cases, fetal surgery is not a cure, but it improves survival rates, function, and long-term health outcomes.