What is Fetal Surgery? Purpose, Procedure & Results

Fetal surgery is a specialized medical procedure performed on a developing baby while still in the womb. This remarkable field of medicine allows surgeons to treat certain serious conditions before birth, giving babies the best possible chance for a healthy life. Think of it as giving your baby a head start on healing while they're still growing safely inside you.

What is fetal surgery?

Fetal surgery involves operating on an unborn baby to correct birth defects or life-threatening conditions before delivery. These procedures happen between 18 and 26 weeks of pregnancy, when the baby is developed enough for surgery but still has time to heal before birth.

There are three main types of fetal surgery. The least invasive approach uses tiny instruments inserted through small incisions in your abdomen and uterus. Open fetal surgery requires a larger incision to access the baby directly. Fetoscopic surgery uses a thin, flexible tube with a camera to guide the procedure.

Only certain conditions qualify for fetal surgery. The condition must be severe enough to threaten the baby's life or cause significant disability, and it must be something that can actually be improved by operating before birth.

Why is fetal surgery done?

Fetal surgery is performed when waiting until after birth would put your baby at serious risk or when early intervention can prevent permanent damage. The goal is always to give your baby the best possible outcome by addressing problems while they're still developing.

The most common conditions that may require fetal surgery include several serious but treatable problems. Here's what might lead your medical team to consider this option:

• Spina bifida - an opening in the spine that can cause paralysis and other complications
• Congenital diaphragmatic hernia - when abdominal organs move into the chest cavity
• Twin-to-twin transfusion syndrome - unequal blood sharing between identical twins
• Severe heart defects that could be fatal without early intervention
• Lung masses or cysts that prevent normal lung development
• Severe kidney problems that affect amniotic fluid levels
• Certain brain conditions like hydrocephalus with severe swelling

Your doctors will only recommend fetal surgery if they believe the benefits significantly outweigh the risks. Every case is carefully evaluated by a team of specialists who consider your baby's specific condition and your overall health.

What is the procedure for fetal surgery?

The fetal surgery procedure varies depending on your baby's condition and the type of surgery needed. Your medical team will walk you through every step and make sure you understand what to expect on the day of surgery.

Before the procedure begins, you'll receive anesthesia to keep you comfortable throughout the surgery. The anesthesia also crosses the placenta to keep your baby comfortable during the procedure. Your vital signs and your baby's heart rate will be monitored continuously.

For minimally invasive procedures, surgeons make small incisions in your abdomen and insert thin instruments to reach your baby. The surgeon uses ultrasound guidance to see exactly where to work. These procedures typically take 1-3 hours and involve less recovery time.

Open fetal surgery requires a larger incision in your abdomen and uterus to access your baby directly. The surgeon carefully lifts the part of your baby that needs treatment while keeping the rest of your baby safely inside the womb. This approach is used for more complex conditions that require direct access.

Throughout any fetal surgery, your baby remains connected to you through the umbilical cord. This means your baby continues to receive oxygen and nutrients from you during the entire procedure. The surgical team includes specialists in maternal-fetal medicine, pediatric surgery, and anesthesia.

How to prepare for your fetal surgery?

Preparing for fetal surgery involves several important steps to ensure the best possible outcome for both you and your baby. Your medical team will guide you through this process and answer any questions you have along the way.

Your preparation will begin weeks before the actual surgery date. You'll need comprehensive testing to make sure you're healthy enough for the procedure and to get detailed images of your baby's condition. This typically includes blood tests, heart monitoring, and specialized ultrasounds.

Leading up to your surgery, there are several important things you'll need to do to prepare your body:

• Stop eating and drinking at least 8-12 hours before surgery
• Take any prescribed medications exactly as directed
• Arrange for someone to drive you to and from the hospital
• Pack comfortable clothes and personal items for your hospital stay
• Follow any specific dietary restrictions your team recommends
• Avoid smoking, alcohol, and recreational drugs completely
• Take prenatal vitamins as directed by your doctor

You'll also meet with your entire surgical team before the procedure. This gives you a chance to ask questions and understand exactly what will happen during and after surgery. Many centers also offer counseling support to help you process the emotional aspects of this experience.

How to read your fetal surgery results?

Understanding your fetal surgery results involves looking at both immediate outcomes and long-term progress. Your medical team will explain what the surgery accomplished and what to expect as your pregnancy continues.

Right after surgery, your doctors will assess whether the procedure achieved its goals. For spina bifida surgery, this means checking that the opening in your baby's spine was successfully closed. For heart procedures, it means confirming that blood flow has improved. Your team will use ultrasound and other imaging to verify these results.

The success of fetal surgery is also measured by how well your baby continues to develop after the procedure. Your doctors will monitor your baby's growth, organ function, and overall health through regular check-ups. Some improvements may be visible immediately, while others become apparent as your baby continues to grow.

Your own recovery is equally important to monitor. Your medical team will check that your incision is healing properly and that you're not experiencing any complications. They'll also make sure your pregnancy is progressing normally and that you're not at increased risk for early labor.

How to optimize your recovery after fetal surgery?

Recovery from fetal surgery requires careful attention to both your healing and your baby's continued development. Your medical team will provide specific guidelines, but there are general principles that help ensure the best possible outcome.

Rest is absolutely crucial in the weeks following fetal surgery. Your body needs time to heal from the procedure while continuing to support your growing baby. Most women need to limit physical activity for several weeks and avoid lifting anything heavier than 10 pounds.

Here are the key steps that support optimal recovery for both you and your baby:

• Take all prescribed medications exactly as directed
• Attend all follow-up appointments for monitoring
• Watch for signs of infection like fever, unusual discharge, or increasing pain
• Eat a nutritious diet rich in protein and vitamins
• Stay hydrated by drinking plenty of water
• Get adequate sleep and rest when your body tells you to
• Avoid strenuous activities until cleared by your doctor
• Monitor your baby's movements and report any concerns

Your emotional recovery is just as important as your physical healing. Many women experience a mix of relief, anxiety, and hope after fetal surgery. It's completely normal to feel overwhelmed or worried about your baby's future. Support from family, friends, and counselors can make a significant difference.

What are the risk factors for fetal surgery complications?

Several factors can increase the risk of complications during or after fetal surgery. Understanding these risk factors helps your medical team make the best decisions for your specific situation and prepare for any challenges that might arise.

Your overall health plays a significant role in how well you'll handle fetal surgery. Conditions like diabetes, high blood pressure, or heart problems can make surgery more complex. Your age also matters, as women over 35 or under 18 may face additional risks during any surgical procedure.

Pregnancy-related factors that can increase risks include carrying multiple babies, having too much or too little amniotic fluid, or a history of pregnancy complications. The timing of surgery within your pregnancy also affects risk levels, with procedures earlier in pregnancy generally carrying different risks than those performed later.

The complexity of your baby's condition influences surgical risks as well. More severe defects or those affecting multiple organ systems typically require more extensive procedures. Previous surgeries or scarring in your abdomen can also make fetal surgery more challenging.

What are the possible complications of fetal surgery?

While fetal surgery can be life-saving, it does carry potential complications that your medical team will discuss with you in detail. Understanding these risks helps you make an informed decision about whether fetal surgery is right for your family.

Complications can affect you, your baby, or both. The most immediate risks relate to the surgery itself, while other complications may develop during the remainder of your pregnancy or after birth. Your surgical team works hard to minimize these risks through careful planning and monitoring.

Potential complications for you as the mother include several risks that your medical team will monitor closely:

• Bleeding during or after surgery
• Infection at the incision site or inside the uterus
• Preterm labor or premature delivery
• Rupture of membranes (water breaking early)
• Blood clots in your legs or lungs
• Reactions to anesthesia
• Need for cesarean delivery
• Complications in future pregnancies

Your baby may also face certain risks from fetal surgery. These can include temporary changes in heart rate during surgery, increased risk of growth problems, or complications related to the specific condition being treated. However, for most conditions requiring fetal surgery, the benefits of treatment far outweigh these potential risks.

When should I see a doctor about fetal surgery?

You should discuss fetal surgery with your doctor if routine prenatal testing reveals a serious condition that might benefit from treatment before birth. Most women learn about potential fetal surgery candidates through detailed ultrasounds or other specialized testing during pregnancy.

The conversation about fetal surgery typically begins when your regular obstetrician identifies a concern that requires evaluation by maternal-fetal medicine specialists. This might happen during your routine 20-week anatomy scan or through earlier testing if you're at higher risk for certain conditions.

If you're carrying a baby with a diagnosed condition, you should seek a second opinion about fetal surgery if you have concerns about the treatment plan. Getting multiple expert opinions can help you feel more confident about your decision, whether that's proceeding with surgery or choosing to wait until after birth.

You should also consult with specialists if you're experiencing symptoms that might indicate complications during pregnancy. Severe changes in your baby's movement patterns, unusual pain, or signs of preterm labor all warrant immediate medical attention, especially if you're being considered for fetal surgery.