In utero surgery

Fetal surgery
Schematic illustration of endoscopic fetal surgery for twin-to-twin transfusion syndrome
ICD-9-CM	75.36
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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. There are three main types: open fetal surgery, which involves completely opening the uterus to operate on the fetus; minimally invasive fetoscopic surgery, which uses small incisions and is guided by fetoscopy and sonography; and percutaneous fetal therapy, which involves placing a catheter under continuous ultrasound guidance.

Fetal intervention is relatively new. Advancing technologies allow earlier and more accurate diagnosis of diseases and congenital problems in a fetus.

Most problems do not require or are not treatable through fetal intervention. The exceptions are anatomical problems for which correction in utero is feasible and may be of significant benefit in the future development and survival of the fetus. Early correction (prior to birth) of these problems will likely increase the odds of a healthy and relatively normal baby.

The pregnant woman bears as much, if not more, risk as her fetus during any form of fetal intervention. Besides the general risk that any surgery bears, there is also a risk to the health of the mother's uterus, potentially limiting her ability to bear more children. The risk is higher than from an elective Cesarean section because:

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.