What Is Fetal Surgery (Prenatal Surgery)?

What Is Fetal Surgery (Prenatal Surgery)?

Fetal surgery, also known as prenatal surgery, is an advanced surgical intervention performed while the baby is still in the womb. It is used to treat or manage congenital anomalies or life-threatening conditions before birth. The primary goal of fetal surgery is to reduce complications after delivery and support a healthier outcome for both the baby and the mother.

Advantages of Fetal Surgery and Evolving Technologies

Thanks to major advancements in medical technology, conditions that were once untreatable before birth can now be addressed effectively in the womb.

• Miniature fetoscopes allow direct access to the fetus through tiny incisions.
• Advanced imaging, such as rapid fetal MRI and high-resolution ultrasound, enables early and accurate diagnosis.
• Minimally invasive techniques reduce maternal and fetal trauma compared to traditional open surgery.

When Is Fetal Surgery Recommended?

According to experts at the Yale Fetal Care Center, fetal surgery is considered for the following conditions:

• Spina bifida (myelomeningocele)
• Congenital diaphragmatic hernia (CDH)
• Fetal anemia
• Twin-to-twin transfusion syndrome (TTTS)
• Congenital heart defects

Highlighted Fetal Surgery Procedures

1. Spina Bifida Repair (In-Utero)

• The uterus is surgically opened, and the fetus is operated on while still connected to the placenta.
• The need for a shunt after birth drops from 80% to 40% when surgery is done prenatally.
• Early intervention supports better outcomes in neurological function, bladder, and bowel control.

2. Congenital Diaphragmatic Hernia (CDH) Treatment

• A small balloon is temporarily placed in the fetal trachea to stimulate lung growth.
• This prenatal intervention significantly increases survival rates compared to postnatal repair alone.

3. Fetal Anemia (Intrauterine Transfusion)

• Blood is transfused directly into the umbilical vein under ultrasound guidance.
• Unlike older methods of injecting blood into the fetal abdomen, this modern intravenous approach allows for precise delivery.
• Postnatal complications from maternal antibodies can be minimized, often reducing the need for repeat transfusions.

Benefits of Modern Fetal Surgery

• Dramatically reduces the risk of postnatal complications.
• Can be life-saving in conditions like spina bifida, TTTS, and CDH.
• Involves a multidisciplinary team including perinatologists, fetal surgeons, neonatologists, geneticists, and pediatric neurosurgeons and cardiologists working together.

Who Is a Candidate for Fetal Surgery?

Fetal surgery is typically considered in high-risk pregnancies, but not all patients are suitable.

• Open fetal surgeries (where the uterus is surgically opened) often require planning for a cesarean delivery.
• Fetoscopic (minimally invasive) techniques can reduce trauma to both mother and baby and may allow for more flexible birth options.

Why Genetic Counseling and Center Selection Matter

Choosing the right medical center and team can greatly influence outcomes.

• Families should be offered personalized treatment options.
• The experience of the surgical team and the resources of the fetal center are critical to reducing risks.
• Specialized centers often assign a dedicated care coordinator to support the family throughout the entire process.

Conclusion: The Life-Changing Power of Fetal Surgery

Fetal surgery allows for early intervention in life-threatening conditions while minimizing harm to both mother and baby. With modern techniques and highly skilled teams, outcomes for serious diagnoses like spina bifida, CDH, fetal anemia, and TTTS can be significantly improved.

A multidisciplinary, expert-led approach at a specialized center is key to ensuring the best possible results for you and your baby.