Fetal surgery is performed inside the uterus before a child is born. It is a complex intervention requiring skill and precision. There are generally two types of fetal surgery: open, where the surgeon performs a caesarean section, so the part of the fetus that needs surgery is exposed, and fetoscopic surgery, where a small incision is made and fiber optic telescopes are used to correct any health issues the fetus possesses.
What is it?
If a pregnant woman is carrying a fetus with a known, life-threatening birth defect, fetal surgery may be an appropriate treatment. Treatable birth defects through fetal surgery include cleft palates, conjoined twins, congenital cystic adenomatoid malformation (CCAM), congenital diaphragmatic hernia (CDH), hydrocephalus, laryngeal atresia, lower urinary tract obstruction (LUTO), gastroschisis, spina bifida, and twin-twin transfusion syndrome, among others.
What should I do to prepare?
The mother receiving treatment should make arrangements to have one or several caregivers present before, during, and after the surgery. It is essential that the mother restricts movement and does very little work after the surgery. Many mothers also find this surgery to be emotionally stressful, so it is important to maintain clear communication with the surgical team and emotional supporters. It is recommended to bring keepsakes from home that may comfort you while in the hospital. Additionally, the patient should refrain from taking blood thinners during the week before surgery since these medications increase the risk of bleeding during the operation. The patient should consult with her doctor about the use of blood thinners based on her personal needs since some may be necessary to prevent stroke. Patients cannot eat or drink during the evening before the surgery to avoid complications with anesthesia such as aspiration. When a patient is put under anesthesia, it is possible for food in the stomach to be expelled into the lungs.
What happens during the process?
Fetal surgeries vary according to the patient’s needs. An example of open fetal surgery is the correction of myelomeningocele, a severe form of spina bifida. Open fetal surgery resembles a caesarian section, because a large incision is introduced to open the womb. Fetoscopic surgery is less invasive, using a camera for the surgeon’s view of the fetus and instruments during the surgery. During the surgery, the anesthesiologist will monitor the patient’s heart rate and breathing as well as pain during the procedure. It’s possible for the anesthesiologist to monitor the fetus’s heart rate throughout the surgery. Additionally, a perinatologist is present during the surgery to assist in monitoring the expectant mother and fetus and to order medicines such as tocolytics, which prevent contractions and preterm labor.
What are the risks and potential complications?
Complications of fetal surgeries include, but are not limited to:
- Preterm labor
- Back ache
- Cramping/abdominal tightening
- Pelvic pressure
- Changes in vaginal discharge
- Vaginal fluid leak
- Gas pains
- General pain
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