Fetal Surgery

Fetal surgery is an advanced intervention or procedure to treat a fetal condition while your baby is still in the womb, improving the chances of the best possible outcome.

What is fetal surgery?

Fetal surgery is an evolving field of medicine that uses advanced fetal imaging and diagnostic tools to treat life-threatening situations in babies while in the womb. It may sometimes be referred to as in-utero or prenatal surgery. In-utero means the surgery occurs while you are pregnant and carrying your baby. These procedures are not only seen as fetal interventions but as maternal-fetal medicine interventions due to focus on both you and your baby’s safety before, during and after the procedure—and leading-up to delivery.

When is fetal surgery needed?

While most pregnancies have healthy outcomes, some may be complicated by birth defects. A fetus with a birth defect or other complication that may impact their survival may benefit from surgical intervention to improve their long-term health outcomes.

Who does fetal surgical procedures?

At Riley Children’s, our fetal interventionalists do fetal surgical procedures. A fetal interventionalist is a maternal-fetal medicine doctor with additional training in fetal diagnosis, intervention, and surgery. Fetal interventionalists perform these complex, delicate procedures alongside a highly skilled team of experts who are available 24/7.

The Fetal Center is among only a few fetal care centers across the country and the only in Indiana with the skill and resources to perform these procedures. All fetal interventions are done in a Level IV Perinatal and Level IV Neonatal Center within the Maternity Tower at Riley Children’s—meaning Riley Children’s is equipped to provide comprehensive medical and surgical care to the most medically complex infants and mothers.

What conditions can fetal surgery treat?

The Fetal Center currently provides comprehensive fetal and maternal care for multiple fetal conditions.

Twin-to-twin transfusion syndrome
Lower urinary tract obstruction (LUTO)
Post-urethral valves or urethral atresia
Congenital cystic adenomatoid malformation (CCAM)
Fetal hydrothorax
Fetal pleural effusions associated with hydrops
Chorioangioma
Sacrococcygeal teratoma
Twin reversed arterial perfusion (TRAP) sequence
Amniotic band sequence/syndrome
Spina Bifida (Myelomeningocele)

What fetal surgery procedures are available?

The Fetal Center currently offers multiple fetal interventions.

Selective Fetoscopic laser photocoagulation (SFLP): Corrects the blood-sharing imbalance in a monochorionic twin pregnancy between the “donor” twin and “recipient” twin.
Vesico-amniotic shunt: Provides continuous drainage of fetal bladder, thus reducing further renal damage and increasing amniotic fluid to improve lung development.
Thoracic-amniotic shunt: Provides continuous drainage of fetal pleural space into the amniotic space, thus promoting lung development and reversal of hydrops.
Radiofrequency ablation and selective bipolar cord coagulation: Interruption of vascular supply to a mass that poses a risk to the fetus, twin fetus, and potentially mother.
Amniotic band release: Releases constriction and prevents further damage caused by amniotic bands.
Fetal Blood Sampling: A procedure that involves taking blood directly from the umbilical cord during pregnancy.
Fetal Surgery for Spina Bifida (Myelomingocele): Fetal repair to close a birth defect to reduce morbidity and improve health outcomes.
EXIT Procedure: Secures a baby’s airway to perform lifesaving procedures while the baby is still receiving oxygen through the placenta.

What to Expect

We work with you and your family when it is determined that your baby’s condition requires fetal surgery. Depending on the condition, we will perform surgery as early as 16 weeks gestation. And depending on the fetal condition, we use different surgical techniques. In all minimally invasive cases, anesthesiologists are part of the care team to offer you comfort with spinal block or numbing medicine and discuss the risks and benefits of anesthesia in pregnancy. At Riley Children’s, our Fetal Center offers the following types of interventions for fetal anomalies.

Fetoscopic surgery: This is a minimally invasive technique where the fetal interventionalist operates through small incisions or holes in the uterus.
Percutaneous fetal surgery: This is when an ultrasound is used to guide a needle or similar instrument into the womb to repair the birth defect.

After fetal surgery, you’ll stay at the Maternity Tower for continued monitoring of both you and your baby. And if your baby needs more intensive care, our neonatal intensive care unit (NICU) provides care for their urgent medical needs and offers neonatal surgery after birth, if necessary.

What are the risks associated with fetal surgery?

The most common risks when undergoing fetal surgery include bleeding, infection, preterm delivery, and other complications. While there are risks, fetal surgery is often done to save a fetus’ life or increase their chance of survival after birth. At the Fetal Center, our goal is to prevent life-threatening situations and improve your baby’s chance of survival.

Key Points to Remember

Fetal surgery is an advanced intervention or procedure to treat a fetal condition while your baby is still in the womb.
While most pregnancies have healthy outcomes, some may be complicated by birth defects. A fetus with a birth defect or other complication that may impact their survival could benefit from surgical intervention to improve their long-term health outcomes.
At Riley Children’s, our fetal interventionalists do fetal surgical procedures. A fetal interventionalist is a maternal-fetal medicine doctor with additional training in fetal diagnosis, intervention, and surgery.
While there are risks, fetal surgery is often done to save a fetus’ life or increase their chance of survival after birth.

Locations

In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.