Fetal surgery, a procedure in which surgery is performed on an unborn baby (fetus), is offered in some conditions to improve the long-term outcome after delivery.

At Mayo Clinic, surgeons may perform open fetal surgery if a fetus has been diagnosed before birth (prenatally) with spina bifida.

In one type of spina bifida, myelomeningocele, an opening in the skin on the fetus' back causes part of the spinal cord and coverings to be exposed to amniotic fluid in the uterus. In some cases, fetal surgery has better results than surgery after delivery.

If your doctor finds your unborn baby has a type of spina bifida, myelomeningocele, your doctor may suggest open fetal surgery to treat the condition.

Research has shown open fetal surgery to repair spina bifida had better outcomes than did surgery performed after birth. Open fetal surgery also may reduce complications of spina bifida. However, the surgery has several potential risks to you and your unborn baby.

Before the procedure

A team of doctors in maternal and fetal medicine, pediatric neurosurgery, and other areas evaluates you and your unborn baby with spina bifida to determine whether surgery is an option. Doctors will perform tests, such as ultrasounds and magnetic resonance imaging, to evaluate your unborn baby and determine the exact location of the opening.

Your doctor will carefully and individually explain the potential risks of the procedure to you and your unborn baby. These risks include rupture of your uterus after surgery (uterine rupture), fetal death, operative complications, early labor and potential failure to treat the spina bifida. Your doctor will also inform you about the possible benefits of the procedure and the long-term follow-up care your child will need.

During surgery

If the medical team determines surgery is appropriate for you and the unborn baby, surgery will generally be conducted 19 to 25 weeks into your pregnancy.

During surgery, you'll be given general anesthesia. A large team of specialists works together during the surgery to monitor you and your unborn baby.

Doctors then make an incision in your abdomen to expose your uterus. After opening the uterus, doctors move the unborn baby to allow the pediatric neurosurgeon to perform the procedure. The pediatric neurosurgeon closes the spina bifida opening. Then, doctors replace your amniotic fluid and close your uterus and abdomen. Surgery usually takes about two hours.

After surgery

After the surgery, you'll stay in or near the hospital for six to eight weeks. Doctors will monitor you closely for signs of complications, such as uterine rupture.

Doctors will conduct a planned cesarean delivery at about 37 weeks into the pregnancy. However, if your baby needs to be delivered sooner, doctors will perform a cesarean section at the needed time.

An integrated team of Mayo doctors trained in treating spina bifida cares for your child after his or her birth and helps manage his or her condition.

  • Experience. At Mayo Clinic a team of doctors, including those trained in treating pregnant women with very complex problems (maternal-fetal medicine specialists), treating children with brain and nervous system conditions (pediatric neurosurgeons) and other specialists, has experience performing fetal surgery. Mayo Clinic in Minnesota is one of few medical centers in the United States who perform open fetal surgery.
  • Team approach. Doctors trained in high-risk pregnancies in maternal and fetal medicine work with pediatric neurosurgeons and doctors trained in treating children with medical conditions (pediatricians), treating children with heart conditions (pediatric cardiologists), administering anesthesia (anesthesiologists), performing surgery in children (pediatric surgeons) and other areas to provide your treatment at Mayo Clinic in Minnesota.
  • Continuity of care. After your child is born, an integrated team of doctors continues to provide comprehensive medical care for your child throughout his or her life at Mayo Clinic in Minnesota.
  • Research. Doctors study how to lower the risks of fetal surgery and improve outcomes.

Watch Mayo Clinic neurosurgeon Nicholas Wetjen, M.D., discuss prenatal surgery for repair of myelomeningocele.

Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.

Doctors trained in maternal and fetal medicine and pediatric neurosurgery perform fetal surgery at Mayo Clinic in Minnesota.

For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.

See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.

Mayo Clinic doctors in maternal and fetal medicine, pediatric neurosurgery, and other areas study fetal surgery, including how to improve outcomes and reduce risks of the procedure.

Doctors in pediatric neurology study potential treatments for spina bifida and other neurological conditions.

March 04, 2013