Overview

Fetal surgery is a procedure performed on an unborn baby (fetus) in the uterus (in utero) to help improve the long-term outcome of children with specific birth defects. Because these defects often worsen as a fetus develops, fetal surgery done by a team of experts focuses on treating and improving the conditions before birth.

Comprehensive health centers that have fetal surgery expertise and experience can treat many birth defects in utero, including:

Types

Methods for treating these conditions at highly specialized health care centers with fetal surgery expertise include:

  • Fetoscopic endoluminal tracheal occlusion (FETO) for severe CDH
  • In utero open or fetoscopic repair of myelomeningocele, the most severe form of spina bifida
  • Open fetal surgery for SCT resection
  • Open fetal surgery to remove CCAM of the lung
  • Shunt placements
  • Fetal vesicoamniotic shunt (VAS) and fetal cystoscopy for bladder obstruction
  • Fetoscopic laser ablation for TTTS and TAPS
  • Bipolar cord coagulation for TRAP sequence
  • Radiofrequency ablation for fetal tumors
  • Ex utero intrapartum treatment (EXIT)
  • Fetal cardiac intervention
  • Intrauterine blood transfusion
  • Serial amnioinfusions for bilateral renal agenesis and complex renal diseases

    Fetal surgery: Birth defects and treatment procedures

    Why it's done

    Before a baby is born, early intervention using fetal surgery can treat life-threatening birth defects and improve outcomes in some cases. For example, if a baby has been diagnosed before birth with spina bifida, surgeons might perform open fetal surgery or a less invasive procedure using a fetoscope.

    Risks

    Potential risks of the procedure — both the risks to you and those to the unborn baby — should be explained by the doctor. These risks include rupture of the uterus after surgery (uterine rupture), fetal death, operative complications, early labor and potential failure to treat the birth defect.

    Results

    When done by fetal surgery experts in select babies, this early intervention can have better results than surgery after delivery. This means that children with spina bifida, for example, may be significantly less disabled as they go through life than they would have been if they had surgery after birth.

    Clinical trials

    Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

    Fetal surgery care at Mayo Clinic

    Sept. 14, 2019
    1. Ruano R, et al. Fetal surgery: How recent technological advancements are extending its applications. Expert Review of Medical Devices. 2019; doi: 10.1080/17434440.2019.1641404.
    2. Ruano R, et al. Lower urinary tract obstruction: Fetal intervention based on prenatal staging. Pediatric Nephrology. 2017; doi: 10.1007/s00467-017-3593-8.
    3. Kilby M, et al. Percutaneous laser ablation of the feeding vessel in pulmonary sequestration or hybrid lesions. Ultrasound in Obstetrics & Gynecology. 2017; doi: 10.1002/uog.17506.
    4. Ruano R, et al. Regenerative Prophylaxis In Utero. Clinical Pharmacology & Therapeutics. 2019; doi: 10.1002/cpt.1262.
    5. Enninga EA, et al. Fetal surgery for lower urinary tract obstruction: The importance of staging prior to intervention. Minerva Pediatrica. 2018; doi: 10.23736/S0026-4946.17.05105-2.
    6. Ruano R, et al. Fetoscopic therapy for severe pulmonary hypoplasia in congenital diaphragmatic hernia: A first in prenatal regenerative medicine at Mayo Clinic. Mayo Clinic Proceedings. 2018; doi: 10.1016/j.mayocp.2018.02.026.
    7. Nassr AA, et al. Outcome of fetuses with lower urinary tract obstruction and normal amniotic fluid volume in the second trimester of pregnancy: A single center experience. Ultrasound in Obstetrics & Gynecology. 2019; doi: 10.1002/uog.20288.
    8. Nassr AA, et al. Effectiveness of vesicoamniotic shunt in fetuses with congenital lower urinary tract obstruction: an updated systematic review and meta-analysis. Ultrasound in Obstetrics & Gynecology. 2017; doi: 10.1002/uog.15988.
    9. Sananes N, et al. Two-year outcomes after diagnostic and therapeutic fetal cystoscopy for lower urinary tract obstruction. Prenatal Diagnosis. 2016; doi: 10.1002/pd.4771.
    10. Sananes N, et al. Technical aspects and effectiveness of percutaneous fetal therapies for large sacrococcygeal teratomas: cohort study and literature review. Ultrasound in Obstetrics & Gynecology. 2016; doi: 10.1002/uog.14935.
    11. Maselli KM, et al. Advances in fetal surgery. Annals of Translational Medicine. 2016; doi: 10.21037/atm.2016.10.34
    12. Goodnight WH, et al. Subsequent pregnancy outcomes after open maternal-fetal surgery for myelomeningocele. American Journal of Obstetrics & Gynecology. 2019; doi: 10.1016/j.ajog.2019.03.008.
    13. Abbasi N, et al. Fetal amenia. Ultrasound in Obstetrics & Gynecology. 2017; doi: 10.1002/uog.17555.
    14. American College of Obstetricians and Gynecologists' Committee on Obstetric Practice. Committee Opinion No. 720: Maternal-fetal surgery for myelomeningocele. Obstetrics & Gynecology. 2017; doi: 10.1097/AOG.0000000000002303.
    15. Miller R. Diagnosis and management of twin reversed arterial perfusion (TRAP) sequence. https://www.uptodate.com/contents/search. Accessed Aug. 29, 2019.
    16. Farmer DL, et al. The management of myelomeningocele study: Full cohort 30-month pediatric outcomes. American Journal of Obstetrics & Gynecology. 2018; doi.org/10.1016/j.ajog.2017.12.001.
    17. Huber C, et al. Update on the Prenatal Diagnosis and Outcomes of Fetal Bilateral Renal Agenesis. Obstetrical and Gynecological Survey. 2019; doi: 10.1097/OGX.0000000000000670.
    18. Ruano, R (expert opinion). Mayo Clinic, Rochester, Minn. July 27, 2019.

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