Fetal surgery means operating on a developing fetus while it’s still in your uterus (in utero). It’s usually done to treat a life-threatening birth defect. It’s also done to repair spina bifida (myelomeningocele), improving outcomes for children born with the condition.
Fetal surgery is a procedure on a fetus while it’s still developing in your uterus. It’s also called in-utero or prenatal surgery. Your surgeon might call it “fetal intervention” if it’s simpler or less invasive. Fetal surgeons intervene to save the fetus or improve long-term outcomes after birth.
Some birth defects can threaten a developing fetus. For example, a large lung malformation may compress the fetus’s heart. This can lead to heart failure and death. Other conditions aren’t immediately life-threatening but cause disabilities after birth. Surgeons commonly treat these conditions after delivery. But treating them before birth can improve long-term outcomes.
A team of specialists performs fetal surgery. This may include:
Fetal surgery is still a new and emerging field in medicine. It’s only been around for about 30 years. There are only about 20 hospitals that offer fetal surgery in North America. Many centers have experience with the most common fetal procedures:
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Fetal surgeons use several techniques to operate on the fetus while it’s in your uterus. The technique they use will depend on the condition of the fetus and your health. They include:
Fetal surgery can treat the following fetal conditions:
If you’re carrying a fetus with a congenital disorder, your healthcare team closely monitors you and the fetus. They’ll let you know exactly what condition affects the fetus, and determine a prognosis. They’ll then work with you and your family to help determine the best care plan.
It depends on what condition affects the fetus. Fetal surgeons can do some minimally invasive procedures as early as 16 weeks. For more complex procedures, the ideal window is between 22 and 26 weeks of development.
Fetal surgeons use different procedures to treat different conditions. For minor procedures, fetal surgeons use ultrasound and fetoscopy to visualize the fetus and then guide surgical instruments through small holes. Open surgery is more complex. Surgeons have to take care to keep the amniotic environment intact while operating. They use special staplers to prevent leaking and continuous infusions to replace lost amniotic fluid.
Specific fetal interventions include:
You’ll stay in the hospital for several hours to several days, depending on your procedure. Your healthcare team will continue to watch you and the fetus closely. Sometimes, they need to deliver early. For some procedures, you’ll need a planned C-section delivery even if your pregnancy continues to term. After birth, some babies need intensive care.
In most cases, healthcare providers only recommend prenatal surgery to save the fetus. Spina bifida is the exception to this rule. Since spina bifida symptoms progress as the fetus develops, repairing it earlier can reduce the damage it causes. Children born with repaired spina bifida are less likely to need treatment for hydrocephalus. They’re also more likely to have bowel and bladder control and be able to walk.
Your risks include:
The fetus’s risks include:
If the fetus has a life-threatening defect and you’ve been told nothing can be done to save it, chances are something can be done. The field of fetal surgery is constantly advancing. And fetal surgeons continue to explore new strategies for treating congenital disorders. Get in touch with a hospital that specializes in fetal surgery. They’ll give you a personalized consultation to explore your options.
A note from Cleveland Clinic
When a congenital condition complicates your pregnancy, stress and emotions are high. This can make the decision process especially difficult for you and your family. You want the best outcome for everyone involved. Your healthcare team wants that, too. They’re there to offer you the information you need and the treatment you choose. They’ll be on your side, wherever your risk assessment lands.
Last reviewed by a Cleveland Clinic medical professional on 04/07/2023.
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