Fetal Surgery

Although most pregnancies have healthy outcomes, 3-5% of all births are complicated by a birth defect (also known as a congenital anomaly).  Fortunately, improvements in technology, related both to prenatal imaging and prenatal testing, have allowed a better understanding of fetal development.  These improvements in knowledge have increased our ability to diagnose and treat many conditions both before and after a baby is born.  The ability to treat certain conditions that are disabling or pose a threat to a baby’s life before birth, offers hope to many families faced with these challenging circumstances.  Michigan Medicine’s Fetal Diagnosis and Treatment Center (FDTC) offers comprehensive fetal diagnosis, multidisciplinary counseling and fetal surgery when appropriate, to provide the highest level of care to these families.

What is fetal surgery?

Fetal surgery, or fetal therapy, refers to any procedure performed on a fetus. There are varying types of fetal surgeries offered that can potentially treat many different conditions.  These are complex surgical procedures, requiring specialized expertise for the care of both the mother and the baby.  A team, consisting of maternal fetal medicine, pediatric surgery, neonatology, pediatric cardiology, pediatric neurosurgery, and many other experts, come together to diagnose, counsel, and closely follow a pregnancy.  The thorough evaluation results in identifying conditions and determining the optimal timing for any fetal interventions.  Although not every condition is able to be treated prior to birth, the fact that some conditions are treatable offers hope to many families.

Michigan Medicine’s Fetal Diagnosis and Treatment Center has been providing fetal surgery to patients since 2006, offering the full spectrum of fetal care. We are experienced in the diagnosis and extensive counseling required to help a patient or family make the best decision for them.  We have an inclusive team which recognizes that these complex procedures require a multidisciplinary approach to decision making and providing care.  We offer ongoing compassionate care to all families by providing the information and support needed to make the best decisions for each individual.

What types of fetal surgery are offered at Michigan Medicine?

There are many types of fetal surgery offered by the Fetal Diagnosis and Treatment team:

Open fetal surgery

The most invasive form of fetal therapy involves an incision into the uterus to allow access for our multidisciplinary team to operate on the fetus while still in the womb.  After the surgery is completed, the uterus is closed and the pregnancy continues to deliver later in pregnancy.

Open fetal surgeries include:

  • Fetal myelomeningocele (fetal surgery for spina bifida)
  • Resection of large sacrococcygeal teratoma
  • Congenital pulmonary airway malformation (CPAM) causing heart failure and not responding to medical treatments

Minimally invasive fetoscopic surgery

This less invasive approach uses a very small incision in the uterus to allow entry of a small fetoscope into the womb through which a camera and small instruments can be used to perform surgery.

Minimally invasive fetoscopic surgeries include:

Fetal cardiac surgery

For the 5% of fetal congenital heart diseases that are considered critical, intrauterine intervention may be necessary.  This is a fetal heart surgery using a percutaneous (through the skin) approach to correct defects prior to birth.

Fetal cardiac surgeries include:

  • Aortic valvuloplasty or pulmonary valvuloplasty for aortic or pulmonary stenosis
  • Atrial septostomy for intact atrial septum

Percutaneous fetal surgery

This is the least invasive approach and involves using ultrasound to guide the placement of needles, catheters, shunts, or balloons which can be used for a variety of fetal therapies.

Percutaneous fetal surgeries include:

  • Bladder (vesicoamniotic) shunt placement
  • Chest, (thoracoamniotic) shunt placement for pleural effusions or macrocystic CPAM
  • Complicated monochorionic diamniotic pregnancy therapies
  • Twin reverse arterial perfusion syndrome (TRAP) therapy
  • Complicated monochorionic monoamniotic twin therapies
  • Intrauterine fetal blood sampling (cordocentesis) and intrauterine blood transfusions

Ex utero intrpartum treatment (EXIT)

This is a specialized cesarean delivery performed at the time of birth. The baby is partially delivered and left attached to the placenta. The operating team of specialists performs needed procedure on the baby to allow the safest transition to life outside the womb. The EXIT procedure is most often used when there is a problem expected with the baby being able to breath at the time of birth.

Next Step

For more information about fetal surgery or to make an appointment at Michigan Medicine’s Fetal Diagnosis and Treatment Center, please call 734-763-4264.