Fetal Surgery

Fetal surgery refers to surgical procedures performed on a fetus while it is still in the womb. These procedures are typically done to treat conditions that can be life-threatening or cause significant morbidity if left untreated before birth.

Types of Fetal Surgery

• In utero surgery: This type of surgery involves making an incision in the mother's abdomen and uterus to access the fetus. The surgeon then performs the necessary procedure on the fetus before closing the incision.
• Ex utero intrapartum treatment (EXIT): This procedure involves partially delivering the baby while still connected to the placenta, allowing for surgical intervention before the umbilical cord is cut.
• Fetoscopic surgery: This minimally invasive technique uses a small endoscope inserted through the mother's abdomen and uterus to visualize the fetus and perform procedures such as laser ablation or shunt placement.

Conditions Treated with Fetal Surgery

• Spina bifida: A birth defect where the spine and spinal cord do not form properly, which can lead to neurological problems and mobility issues.
• Diaphragmatic hernia: A condition where a hole in the diaphragm allows abdominal organs to move into the chest cavity, potentially causing respiratory distress.
• Twin-to-twin transfusion syndrome (TTTS): A condition affecting identical twins who share a placenta, where one twin receives too much blood and the other too little, leading to potential complications for both babies.
• Congenital heart defects: Abnormalities in the structure or function of the heart that can lead to cardiovascular problems.
• Sacrococcygeal teratoma (SCT): A type of tumor that develops at the base of the spine and can cause complications such as bleeding, infection, or damage to surrounding tissues.

Risks and Benefits

Fetal surgery carries risks for both the mother and the fetus, including:

• Premature birth
• Maternal bleeding or infection
• Fetal injury or death
• Placental abruption (separation of the placenta from the uterus)

However, fetal surgery can also offer significant benefits, such as:

• Improved outcomes for conditions that would otherwise be life-threatening or cause significant morbidity
• Reduced need for postnatal surgery or interventions
• Enhanced quality of life for the child and family

Postoperative Care

After fetal surgery, the mother is typically monitored closely in the hospital for several days to ensure that she and the fetus are recovering well. The fetus is also monitored with regular ultrasounds to assess its condition and detect any potential complications.

Long-term Outcomes

The long-term outcomes of fetal surgery vary depending on the specific condition being treated and the individual circumstances of each case. In general, studies have shown that fetal surgery can improve outcomes for certain conditions, such as spina bifida and TTTS. However, more research is needed to fully understand the long-term effects of these procedures.