Fetal surgery
| Fetal surgery | |
|---|---|
| Intervention | |
| ICD-9-CM | 75.36 |
Fetal surgery is any of a broad range of surgical techniques that are used to treat birth defects in fetuses who are still in the pregnant uterus.
are generally given to prevent labor; however, these should be given if the risk is higher for the fetus inside the womb than if delivered, such as may be the case in intrauterine infection, unexplained vaginal bleeding and fetal distress. An H2 antagonist is usually given for anaesthesia the evening before and the morning of the operation, and an antacid is usually given before induction to reduce the risk of acid aspiration.Rapid sequence induction is often used for sedation and intubation.
Open fetal surgery is similar in many respects to a normal cesarean section performed under general anesthesia, except that the fetus remains dependent on the placenta and is returned to the uterus. A hysterotomy is performed on the pregnant woman, and once the uterus is open and the fetus is exposed, the fetal surgery begins. Typically, this surgery consists of an interim procedure intended to allow the fetus to remain in utero until it has matured enough to survive delivery and neonatal surgical procedures.
Upon completion of the fetal surgery, the fetus is put back inside the uterus and the uterus and abdominal wall are closed up. Before the last stitch is made in the uterine wall, the amniotic fluid is replaced. The mother remains in the hospital for 3–7 days for monitoring. Often babies who have been operated on in this manner are born pre-term.
The main priority is maternal safety, and, secondary, avoiding preterm labor and achieving the aims of the surgery. Open fetal surgery is possible first after approximately 18 weeks of gestation due to fetal size and fragility before that, and up to approximately 30 weeks of gestation due to increased risk of premature labor and, practically, the preference for delivering the child and performing the surgery ex utero instead. The risk of premature labor is increased by concomitant risk factors such as multiple gestation, a history of maternal smoking, and very young or old maternal age.
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