If you are a pregnant mother, you probably always wonder if everything is okay with your baby. Every time you have a scan, you feel a little nervous. Sometimes, unexpectedly, the scan reveals that your baby has a birth defect. It is difficult to put into words the sadness and fear you feel at such a time. However, medicine is very advanced today. Did you know that you can correct the problem by performing surgery while the baby is still in the womb, without waiting for the baby to be born? That is what we call 'Fetal Surgery'.
Simply put, what is Fetal Surgery?
Fetal surgery, simply put, is surgery performed on a baby while it is still developing inside your uterus. Some doctors also call it prenatal surgery. It involves intervening and treating a complication that could be life-threatening or cause serious disability in the baby after birth. The hope is to save the baby's life or increase the baby's chances of living a healthy, productive life after birth.
In what cases is this type of surgery necessary?
This type of surgery is not done for every birth defect. It is only done in very serious, special cases. Think of it this way.
- If there is an immediate threat to the baby's life: For example, imagine that a large tumor (lung malformation) has formed in the baby's lungs, which is pressing on the baby's tiny heart. If that happens, the baby could go into heart failure while still in the womb, which could be life-threatening. In such a case, doctors can perform surgery to remove the tumor while still in the womb.
- Reduce postnatal disabilities: There are some conditions that are not immediately life-threatening for the baby, but can cause serious disabilities after birth. A good example is spina bifida, a spinal condition in which the baby's spinal cord does not close properly. This can damage the nerves, making it difficult for the baby to walk or control their bowels and bladder after birth. If this surgery is performed while the baby is still in the womb, it can reduce the damage to the nerves and give the baby a better life after birth.
The most important thing is that the decision to perform this surgery is made with great care, after considering many factors regarding the health of both the mother and the baby.
Who performs this kind of surgery?
This is not just any surgery. It requires a large team of highly specialized doctors. It's like a team of superheroes. This team usually includes:
- Pediatric Surgeons: These are the main characters. They have received special training to perform surgeries on babies after they are born, even inside the womb.
- Maternal-fetal medicine specialists: These are specialists who specialize in complications that occur during pregnancy. They look after the health of both the mother and the baby.
- Anesthesiologists: People who have received special training in administering anesthesia (numbing out consciousness) to both mother and baby.
- Fetal Cardiologists: Those who specifically look at the functioning of the baby's heart.
- Fetal Imaging Specialists: Those who use state-of-the-art ultrasound and MRI technology to give doctors a clear picture of the baby's condition.
Everyone is working together to make this complex surgery a success.
What are the main methods of fetal surgery?
Doctors have several methods for performing this surgery. The method to be used is decided based on factors such as the baby's condition and the mother's health. Let's look at the main methods.
| Surgical method | Description |
|---|---|
| Open Fetal Surgery | In this, the mother is given general anesthesia. After that, the doctor cuts the mother's abdomen and removes the uterus. Then, the uterus is also cut a little and the baby is treated. But the baby is not completely removed from the uterus. When the surgery is finished, the uterus and abdomen are carefully sewn back together. Then, the pregnancy is continued as long as possible. |
| Fetoscopic Surgery | This is like 'keyhole surgery'. Instead of making a large incision, only a few very small holes are made in the abdomen and uterus. Through these holes, a thin tube with a small camera attached to it, called a fetoscope, is inserted. Based on the images from the camera, the doctor uses thin instruments inserted through other holes to perform the surgery. This is less traumatic for the mother. |
| Surgery performed at the time of delivery (EXIT Procedure) | This is a very special procedure. EXIT stands for Ex-utero Intrapartum Treatment. This is done if there is something like a large tumor on the baby's neck, or if there is a blockage in the airway. In this, the uterus is opened like a cesarean section (C-section), and only the baby's head and shoulders are taken out. But the umbilical cord is not cut. Since the baby is still connected to the placenta, it gets oxygen from the mother. In the meantime, the doctors prepare the baby's airway and make it able to breathe on its own. Only then is the umbilical cord cut and the baby is completely taken out. |
What conditions are treated with these surgeries?
- Spina Bifida/Myelomeningocele: A congenital defect of the spinal cord.
- Congenital Lung Malformations: Tumors or abnormal growths in the lungs.
- Congenital Diaphragmatic Hernia (CDH): Abdominal organs protrude into the chest cavity.
- Monochorionic Twin Complications: Conditions such as Twin-to-Twin Transfusion Syndrome that occur in twins who share the same placenta.
- Sacrococcygeal Teratoma (SCT): A large tumor that develops at the base of a baby's spine.
- Congenital High Airway Obstruction Syndrome (CHAOS): A condition in which the baby's airway is blocked from birth.
- Lower Urinary Tract Obstruction (LUTO): Blockage of the baby's urinary tract.
What happens before and after the surgery?
Before surgery
If your baby is diagnosed with one of these complications, your medical team will monitor you and your baby very closely. They will explain to you clearly about your baby's condition, its severity, and the treatment options available. This is a very difficult time for you and your family. Therefore, your medical team will work with you to help you decide on the best treatment plan for everyone.
After the surgery
After the surgery, you will need to stay in the hospital for a few days, depending on the type of surgery. During that time, the medical team will continue to monitor you and your baby. Sometimes, a preterm delivery may be necessary. Also, if this type of surgery is performed, the baby will most likely be delivered by a planned C-section. After the baby is born, the baby may need further care in the Intensive Care Unit.
What are the benefits and risks?
Like any surgery, this one has both benefits and risks. It is important to be well informed about both before making a decision.
| Benefits | Risks |
|---|---|
| Benefits for the baby | |
| This surgery is often done to save the baby's life . In conditions like Spina Bifida, early surgery can reduce nerve damage, which can help the baby's ability to walk and control their bladder after birth. | |
| Risks to mother and baby | |
Risks to the mother:
| Possible risks to the baby:
|
When you find out that your baby has a birth defect, it's normal to feel overwhelmed, sad, and scared. Making decisions can be difficult at times. But remember, you're not alone. Your doctor and medical team are there to help you. They can give you all the information you need and guide you to make the best choices for you and your baby.
Take-Home Message
- Fetal Surgery is a specialized surgery performed while the baby is still inside the womb. This is done to save the baby's life or reduce serious disabilities.
- This is not something that is done for every birth defect. It is only done in very serious, selected cases.
- This requires the support of a highly specialized medical team.
- There are several main methods, including open surgery, keyhole surgery (fetoscopic), and surgery performed at the time of birth (EXIT).
- This surgery has its benefits, but it also carries risks for both mother and baby. Before making any decisions, discuss this with your doctor.
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