Fetal Surgery: Procedures, Timing & Conditions Treated

Fetal surgery involves operating on a fetus in utero to correct life-threatening or debilitating conditions. It is a highly specialized field performed during the second or third trimester (typically 18–26 weeks) when fetal development permits intervention.

Key Aspects

• Purpose: Correct or mitigate congenital anomalies, structural defects, or functional disorders before birth.
• Timing: Usually 18–26 weeks gestation, balancing fetal maturity against preterm birth risks.
• Techniques:
  • Open fetal surgery: Incision in abdomen and uterus for direct access.
  • Minimally invasive fetal surgery (MIFS): Smaller incisions and instruments.
  • Fetoscopic surgery: Camera and instruments inserted via small ports.

Conditions Treated

• Spina bifida: Closing the spinal defect to reduce paralysis and complications.
• Congenital diaphragmatic hernia (CDH): Repairing the diaphragm to allow normal lung development.
• Twin-to-twin transfusion syndrome (TTTS): Laser ablation of shared placental vessels to balance blood flow in monochorionic twins.

Risks & Outcomes

Risks include preterm labor, infection, placental abruption (mother), and prematurity or surgical complications (fetus). Outcomes depend on the condition, gestational age, and surgical expertise. Many procedures significantly improve long-term prognosis and quality of life.

Decisions require thorough counseling by a multidisciplinary fetal care team to weigh risks, benefits, and alternatives.