Fetal surgery is any surgical procedure performed before the baby is born, while still in utero. Fetal surgery frequently allow surgeons to intervene early, before health issues or birth defects become more ominous. Certain birth defects may be exacerbated by the labor and delivery event and may even progress so quickly after birth as to cause extreme disability or death.
A condition called myelomeningocele, or spina bifida, is a birth defect where the spine does not close properly during fetal development. When this occurs, the spinal cord may be exposed or protrude through an open area in the lower portion of the back. If spina bifida fetal surgery is not performed, complications, such as neurological problems, paralysis, fluid in the brain, and bladder and bowel problems, may occur.
Typically, open fetal surgery is performed if fetal laser surgery, or endoscopic surgery, is not an option. Fetal surgery generally entails an incision being made through the mother's abdomen and part of the uterus being removed from the abdominal cavity. After a portion of the uterus is removed from the abdomen, often the amniotic fluid is then drained and kept warm for replacement when the procedure is completed. An incision is then made in the uterus, allowing the surgeon to perform the procedure on the fetus.
Generally, once a birth defect is discovered, doctors determine if fetal surgery will be an appropriate intervention. Fetal surgery is usually reserved for only the most extreme conditions that are likely to cause death or profound disability. If fetal surgical intervention is deemed appropriate, the parents, surgical team and other health care providers will meet to discuss the procedure.
Prior to the surgery, a steroid may be given to the patient to hasten fetal lung development. Next, a comprehensive physical examination will be done. Typically, a fetal monitor will be put in place to monitor the fetal heart rate and maternal uterine contractions. The maternal patient will not be allowed to eat or drink after midnight on the day of the surgery, and she will sign a consent form. Blood tests, called typing and cross matching, may be performed in case a blood transfusion is needed.
Recovery from fetal surgery typically takes up to ten days. The maternal patient will be watched closely for signs of premature labor; the physician may also recommend bed rest to decrease the risk. Some signs of premature labor include uterine contractions, abdominal cramping or pain, and vaginal bleeding.
