In the past, any problems that your baby might have were not known until your baby was born. Birth defects or disorders of the spinal cord, lungs, or other organs or tumors could not be diagnosed before birth.
Now, with the use of ultrasound and other types of imaging, many types of problems with a developing fetus can be diagnosed well before birth. While it helped to know about problems in advance, until relatively recently obstetricians, pediatricians, and surgeons could only fix the situation after the baby was born. But waiting until the birth meant that some fetuses did not survive that long or that they would need one or more surgeries after they were born.
Starting in the 1980s, fetal surgery was developed that could correct some types of problems before the baby is born. In some cases, surgeons make an incision into the uterus to operate directly on the fetus, which is called open fetal surgery. The fetus is tucked back into the uterus and the pregnancy would progress. In others, special instruments and fiber-optic viewing equipment are inserted through tiny incisions to fix problems in the fetus or the placenta. This is a less invasive type of surgery. Using instruments to view the fetus inside the uterus is called fetoscopy.
One type of fetal surgery is called EXIT, or ex utero intrapartum treatment procedure, and is actually a type of cesarean section with the baby being delivered right after the surgery. EXIT is performed on babies who will have an immediate and critical problem once the umbilical cord is detached, such as a tumor or malformation that blocks their airways and prevents them from breathing normally. In EXIT, an incision is made in the uterus and the baby’s head and arms are exposed, but the baby is left attached to the umbilical cord and placenta so that it gets oxygen. The baby’s airway is cleared, and the baby’s breathing is established. Then the umbilical cord is cut, and the baby is delivered completely.
Both open and fetoscopic fetal surgery can be used to correct spina bifida, which is a birth defect where the spine and spinal cord have not formed and closed completely. Spina bifida varies in severity, ranging from minor problems to paralysis and developmental problems. In the past, babies with very severe spina bifida (called myelomeningocele) underwent surgery right after birth and could need several surgeries that would still leave them with paralysis and other problems. Fetal surgery corrects many of the problems of spina bifida better than surgeries done after birth.
Fetoscopy can also be used to correct a rare condition called twin-twin transfusion syndrome, which only occurs in pregnancies with identical twins that share one placenta. In this condition, there are abnormal connections in the blood flow from the placenta and one twin is getting the bulk of the blood. It can be fatal for the twin who is being starved of blood. To correct it, surgeons use a fiber-optic viewing device and guide a laser to disconnect the shared blood vessels in the placenta, allowing both fetuses to get the right amount of blood.
Other conditions that can be cured or helped with fetal surgery include:
- Amniotic band syndrome
- Bronchopulmonary sequestration of the lung
- Congenital cystic adenomatoid malformation of the lung
- Congenital diaphragmatic hernia
- Congenital high airway obstruction syndrome
- Fetal anemia
- Lower urinary tract obstruction
- Mediastinal teratoma
- Neck mass
- Sacrococcygeal teratoma
- Twin anemia-polycythemia sequence
- Twin reversed arterial perfusion sequence
Since its beginnings, fetal surgery has been used successfully thousands of times and the number of conditions and disorders that it can correct or minimize has grown. The risks of fetal surgery have also been reduced as the surgery has become more commonly used to treat several conditions. This reduction in risk is because surgeons, obstetricians, hospitals, and support staff (including nurses, neonatologists, pediatricians, counselors, and others) have become more familiar with the techniques of the surgery.
Fetal surgery, as with every type of surgery, is not without risks. There could be problems with anesthesia or infection. The uterus could rupture at the incision. There is the possibility that the fetus could die or be born very prematurely. The risks to the mother are usually minimal. A cesarean section will be necessary after fetal surgery.
However, the risks of fetal surgery are usually outweighed by the benefits of fixing the birth defect or condition early. Early intervention can save the life of the fetus, prevent a too-early birth, or can help minimize the severity of the problem, allowing the baby to be born with fewer health issues or even be completely healthy. If your baby needs fetal surgery, you will meet with counselors and others to discuss the risks and benefits of the procedure.
Fetal surgery is done in a medical center that specializes in it. It is a difficult surgery that requires very specialized equipment and a trained and experienced staff.