Prenatal Surgery: Helping Babies Before Birth

Operating on a baby before birth may seem like science fiction, but prenatal surgery is becoming more and more common in special pediatric programs throughout the United States.

Since prenatal surgery was first pioneered in the 1980s, it's become an important way to correct certain birth defects that could be severe (and in some cases fatal) if babies were born with them unrepaired.

Prenatal surgery (also called fetal surgery or fetal intervention) most often is done to correct serious problems that can't wait to be fixed, like certain heart defects, urinary blockages, bowel obstructions, and airway malformations.

Some of the greatest successes have come from correcting spina bifida (an often disabling spinal abnormality in which the two sides of the spine fail to join together, leaving an open area). A recent landmark study reports that kids with spina bifida who received fetal surgery typically are more likely to walk, less likely to have serious neurological problems, and less likely to need a shunt to drain brain fluid.

So how does prenatal surgery work? The most common types are:

• Open fetal surgery: In this type of procedure, the mother is given anesthesia, then the surgeon makes an incision in the lower abdomen to access the uterus (as would be done during a Cesarean section). The uterus is opened with a special stapling device that prevents bleeding, the fetus is either partially or completely taken out of the womb, surgery is done, then the baby is returned to the uterus, and the incision is closed. Open fetal surgery is performed for problems like spina bifida and certain other serious conditions. The mother will be in the hospital for 3-7 days and will need a C-section to give birth to the baby (and any future children).
• Fetoscopic surgery: This minimally invasive type of procedure, often called Fetendo fetal surgery, is more common than open fetal surgery. Small incisions are made and the fetus is not removed from the uterus. The surgeon uses a very small telescope (called an endoscope) designed just for this kind of surgery and other special instruments to enter the uterus and correct the problem. Fetendo is most useful for problems with the placenta, such as twin-twin transfusion syndrome in which one identical twin grows at the expense of the other because of abnormal blood vessel connections in the placenta they share.
• Fetal image-guided surgery: Some fetal surgery is done without an incision to the uterus or use of an endoscope. Doctors use ultrasound to guide them as they perform "fetal manipulations," such as placing a catheter in the bladder, abdomen, or chest. The least-invasive form of fetal surgery, it's not used for serious conditions that require open surgery.

The benefits of prenatal surgery don't come without risks, though. Chief among them are premature births and problems with the incision site. Moms who have fetal intervention are closely monitored for preterm labor and receive medications to control it. Still, for many parents and their babies, fetal surgery is a true medical miracle.

Reviewed by: Kate M. Cronan, MD
Date reviewed: December 2011