What Is Fetal Surgery?

Medically Reviewed by Dan Brennan, MD on September 07, 2023
Written by Alexandra Benisek
4 min read

Fetal surgery (also called in-utero or prenatal surgery) is a type of procedure done on your baby while they are still in your uterus. When a fetus has a birth defect, the issue usually gets worse as they develop. A team of experts can treat and improve these defects early before birth. Your doctor may have to perform this type of surgery to save the fetus or help their long-term health. For less severe cases, your surgeon might call it "fetal intervention."

Based on what type of condition affects your fetus, you can have fetal surgery as early as 16 weeks. These procedures are usually less severe. For more complex cases, it's best to have surgery between 22 and 26 weeks of development.

 

Fetal surgery is done to help your baby develop properly. If they have a birth defect, this could lead to complications or even death. Some birth defects or conditions aren't life-threatening, but they could cause disabilities after birth. While some surgeons treat these issues after birth, doing so before birth can help them develop better in the long run.

Who performs fetal surgery?

You'll have a team of specialists do your fetal surgery. In addition to pediatric surgeons, this might include:

  • Maternal and pediatric anesthesiologists
  • Maternal-fetal medicine specialists
  • Fetal cardiologists
  • Fetal imaging specialists
  • Other surgeons who work with fetal needs

Fetal surgery has been around for only about 30 years. Only about 20 hospitals in North America have experts who can do fetal surgery. While the field is new, doctors continue to study and improve it.

Special health care centers with fetal surgery experts can offer you the care you and your baby need. There are many types of fetal surgeries. But the most common ones include:

  • Twin-to-twin transfusion syndrome surgery
  • Repair of spina bifida
  • Ex-utero intrapartum treatment (EXIT) surgeries for rare conditions

Other types of fetal surgery include:

  • Fetoscopic endoluminal tracheal occlusion (FETO) for severe congenital diaphragmatic hernia (CDH)
  • Shunt placements 
  • Fetal vesicoamniotic shunt (VAS) and fetal cystoscopy for bladder obstruction
  • Open fetal surgery for sacrococcygeal teratoma (or SCT, a tumor on the tailbone of the fetus) resection
  • Open fetal surgery to remove congenital cystic adenomatoid malformation (CCAM) of the lung
  • Fetoscopic laser ablation for twin-twin transfusion syndrome (TTTS) and twin anemia-polycythemia sequence (TAPS), conditions in which twins have problems with blood flow
  • Radiofrequency ablation for fetal tumors
  • Bipolar cord coagulation for twin reversed arterial perfusion (or TRAP,  which can happen when twins develop unequally) sequence
  • Fetal cardiac intervention
  • Intrauterine blood transfusion
  • Serial amnioinfusions for bilateral renal agenesis and complex renal diseases

These surgeries can treat multiple birth defects such as:

  • Spina bifida (myelomeningocele)
  • Twin anemia-polycythemia sequence (TAPS)
  • Twin reversed arterial perfusion (TRAP) sequence
  • Twin-twin transfusion syndrome (TTTS)
  • Amniotic band syndrome
  • Bronchopulmonary sequestration of the lung
  • Lower urinary tract obstruction (LUTO)
  • Mediastinal teratoma
  • Neck mass that interferes with air flow
  • Sacrococcygeal teratoma (SCT)
  • Congenital cystic adenomatoid malformation (CCAM) of the lung
  • Congenital diaphragmatic hernia (CDH)
  • Congenital high airway obstruction syndrome (CHAOS)
  • Fetal anemia

The survival rate for fetal surgery differs based on the specific type. Twin-to-twin transfusion syndrome (which has a 70% to 100% risk of death for the fetus before surgery) has a survival rate of 85% after surgery. This procedure creates a huge difference in the survival of a fetus.

Fetal surgery can use many methods. Your surgeon will decide on the best way to perform the surgery based on the condition of your fetus and your own health. The methods include:

Fetoscopic surgery. Your surgeon will operate through a small hole in your uterus. This method is minimally invasive (which means there are smaller cuts and less recovery time). Sometimes, they'll use a small camera to operate.

Open surgery. You'll be under general anesthesia (in a deep sleep) for this type of surgery. Your surgeon will cut through your belly and into your uterus to get to the fetus. Your fetus will stay inside of you while they operate. They'll close your uterus and belly after so that your pregnancy can continue as normal as possible.

Surgery at delivery. EXIT procedures happen during surgical delivery. You'll be under general anesthesia with medication to relax your uterus. They'll open your uterus and partially deliver the fetus. Then, they'll make sure your baby is stable before they cut the umbilical cord. This type of surgery can help ease a blocked airway or take out a large tumor that was harming your baby.

Fetal surgery has some risks, just as any other operation does.

The possible risks for you include:

  • You may need to deliver your baby or future babies through cesarean section.
  • Blood loss could lead to needing a blood transfusion.
  • Uterine scar thinning or reopening can add risks to pregnancies in the future.
  • You could have medication side effects, including low blood pressure and slow or shallow breathing.

The potential risks for you baby include:

  • Placental abruption, which could cause your fetus to lose the nutrients they need
  • Chorioamniotic membrane separation, which can lead to more issues with your fetus
  • Preterm labor from surgery
  • Chorioamnionitis, which is a rare infection of your amniotic fluid