Fetal Surgery 101

Only in the past ten years have doctors been performing actual fetal surgery.  This new technology is changing the face of pregnancy and is raising the statistics of babies who are able to survive outside the womb with problems that would have previously lowered their survival rates.  Amniocentesis, the testing of amniotic fluid, has been practiced on a regular basis for more than 20 years.  However, actually performing surgery on a growing fetus is a new and very exciting field of modern medicine.

Two Types of Fetal Surgery

There are two ways that this type of surgery is performed.  If, for instance, doctors see that a baby is developing with a diaphragmatic hernia, they can proceed in one of two ways.  This condition is easily corrected in an adult with surgery.  In a developing fetus, however, this condition would mean that there is a hole in the diaphragm which creates a lack of balance with regular development.  It can potentially be fatal for a fetus, because the stomach can move into the chest, preventing the lungs from developing, which can cause lung hypoplasia and death. 

With fetal surgery, doctors can correct this situation and offer a growing fetus the chance to develop normally.  Open fetal surgery requires the baby to be partially extracted from the womb for the problem to be fixed.  In utero surgery involves doing the surgery through the uterine walls using fiber optics, needles and small instruments.  Certain conditions require open fetal surgery and other conditions call for in utero surgery.

Doctors are Learning Each Day

Many surgeons today around the world are learning more about fetal surgery.  There are four pioneering doctors at WSU School of Medicine - Dr. Alan Flake, Dr. Mark Evans, Dr. Mark Johnson, and Dr. Ruben Quintero who are the leading researchers in the area of fetal surgery.

UCSF also has a team of doctors who use fetal surgery for many patients today at their center called the Fetal Treatment Center.

What Risks Does this Pose to the Mother?

The doctors certainly want to help the growing fetus to thrive, but their number one consideration is for the mother's health.  Open surgery requires general anesthesia and an abdominal incision.  It also creates the risk of preterm labor and the woman has to be monitored closely and given drugs to prevent this consequence.   She may need to have Cesarean delivery for this pregnancy, and for future pregnancies as well.

Fetal surgery involves regional or local anesthesia.  The woman does run the risk of having a membrane puncture and amniotic fluid leakage, which can lead to preterm labor and other complications. 

Doctors are constantly weighing the risk to the mother and the benefit to the baby when deciding whether or not to perform fetal surgery.  They take these factors into great consideration when choosing which surgery to perform, and whether or not to do fetal surgery at all.

This is a constantly developing and growing field.  The potential is amazing for saving the lives of babies and for helping babies to develop properly while still in the safety of the uterus. 


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