Fetal surgery: Techniques, Treatments, and Success rates

Fetal surgery is a revolutionary field in medicine that addresses birth defects and other conditions while a baby is still in the womb. With advancements in medical technology, doctors can now perform surgeries on fetuses to correct or minimize life-threatening or debilitating issues before birth. This offers hope to families dealing with complex prenatal diagnosis. In this blog, we’ll explore the various fetal surgery techniques, the treatments available, common conditions treated, advantages, and success rates.

What is Fetal surgery?

Fetal surgery, also known as prenatal surgery or in utero surgery, involves performing surgical procedures on a fetus while still in the mother’s womb. The goal is to treat certain birth defects early, improving the baby’s chances of survival or reducing long-term health complications.

Available techniques in Fetal surgery

Open fetal surgery: Open fetal surgery is the most invasive approach. It involves making incisions in the mother’s abdomen and uterus to access the baby. After partially removing the baby, the surgery is performed, and the baby is then placed back inside the womb to continue developing. This is typically used for conditions like spina bifida.

Fetoscopic surgery: Fetoscopic surgery is a minimally invasive technique that involves inserting a small camera (fetoscope) and instruments through tiny incisions in the uterus. This is used to treat conditions like twin-to-twin transfusion syndrome (TTTS) and amniotic band syndrome.

Percutaneous fetal therapy: This technique uses needles or catheters to deliver treatments to the fetus, such as blood transfusions or medications. This method is used for conditions like fetal anemia and urinary blockages.

Types of fetal surgery treatments

In addition to surgical techniques, several specialized treatments can be used to treat specific fetal conditions. These treatments are less invasive than traditional surgeries and offer unique approaches to resolving life-threatening fetal issues.

1. Bipolar cord coagulation:

This is a minimally invasive procedure used in cases of selective intrauterine growth restriction (sIUGR) or twin reversed arterial perfusion (TRAP) sequence. In the TRAP sequence, one twin lacks a functioning heart and relies on blood from the healthy twin, which can put the healthy twin at risk. Bipolar cord coagulation involves using an electric current to seal the umbilical cord of the affected twin, stopping the abnormal blood flow and protecting the healthy twin. This treatment has a good success rate and is considered less risky for the mother and fetus than more invasive procedures.

2. Radiofrequency Ablation (RFA):

RFA is another minimally invasive technique used in cases of TRAP sequence and other twin-related conditions. A needle is inserted through the mother’s abdomen into the umbilical cord or the abnormal tissue of the affected twin, and radiofrequency energy is applied to destroy the tissue. By cutting off the blood supply, this treatment reduces the risk to the healthy twin. RFA is also used for treating certain fetal tumors and congenital heart defects.

3. Intrauterine Blood Transfusion (IUT):

In cases where the fetus suffers from fetal anemia, often due to Rh disease or infections like parvovirus, an intrauterine blood transfusion can be lifesaving. This involves delivering compatible blood directly into the fetus’s umbilical vein, replenishing red blood cells and improving the baby’s health. Intrauterine transfusions have a high success rate and are a critical treatment for fetal anemia.

4. Laser treatment (Fetoscopic laser surgery):

This is commonly used to treat twin-to-twin transfusion syndrome (TTTS), a condition in which blood flows unevenly between twins who share a placenta. During this procedure, a fetoscope is inserted into the uterus, and a laser is used to seal off the shared blood vessels that are causing the imbalance. This treatment helps both babies develop more evenly and reduces the risk of severe complications. Laser treatment has a high success rate, often allowing both twins to be born healthy.

Most common conditions treated by fetoscopic methods

1. Twin-to-Twin Transfusion Syndrome (TTTS):

TTTS occurs when identical twins share a placenta, and blood vessels allow blood to flow unevenly between them. Fetoscopic laser surgery is the primary treatment for this condition, helping to balance blood flow and improve survival rates for both twins.

2. Spina bifida:

In this condition, the spine and spinal cord do not form properly, which can lead to physical and neurological disabilities. Fetal surgery to close the gap in the spine helps protect the spinal cord and reduces the risk of further damage.

3. Congenital Diaphragmatic Hernia (CDH):

CDH is a defect in the diaphragm that allows abdominal organs to push into the chest, restricting lung development. Fetal surgery can place a balloon in the fetus’s airway to stimulate lung growth, improving post-birth outcomes.

4. Fetal tumors:

Some babies develop tumors, like sacrococcygeal teratomas, while in the womb. Depending on the size and impact of the tumor, fetal surgery can be performed to remove or reduce it, preventing life-threatening complications.

5. Fetal anemia:

In cases of severe anemia, intrauterine blood transfusions help save the fetus by replenishing their blood supply and preventing organ failure.

Advantages of fetal surgery

Early intervention: Treating conditions before birth can prevent complications after delivery and improve survival rates.
Reduced long: Term Health Issues: Fetal surgery can help prevent permanent disabilities, such as paralysis or brain damage.
Increased quality of life: Babies treated for conditions like spina bifida or TTTS have better mobility and overall health outcomes.
Optimized brain development: For conditions like hydrocephalus, early intervention helps reduce pressure on the brain, allowing it to develop more normally.

Success rates of fetal surgery

The success rates for fetal surgery vary depending on the condition being treated and how early the problem is diagnosed.
Spina bifida: Open fetal surgery for spina bifida has success rates of 80–90%, with significant improvements in mobility and neurological function compared to post-birth treatment.
Twin-to-Twin Transfusion Syndrome (TTTS): Fetoscopic laser surgery for TTTS has success rates ranging from 70–85%, and most twins are born healthy after treatment.
Congenital Diaphragmatic Hernia (CDH): Fetal surgery for CDH can improve lung development, with survival rates increasing significantly when the condition is treated before birth.
Fetal anemia: Intrauterine blood transfusions for fetal anemia have very high success rates, often exceeding 90%, when performed in experienced centers.

Challenges and Risks

Fetal surgery is not without risks. Potential complications include preterm labor, infection, and complications related to anesthesia. The mother and fetus must be closely monitored throughout the procedure and pregnancy. While risks exist, the benefits often outweigh them, particularly for conditions that are life-threatening or debilitating.

Conclusion

Fetal surgery is an extraordinary medical breakthrough that provides hope for babies diagnosed with severe conditions in the womb. With techniques like open fetal surgery, fetoscopic procedures, and specialized treatments such as laser surgery and intrauterine blood transfusions, doctors can address a variety of conditions before birth. The success rates are encouraging, and as the field continues to evolve, the future looks even brighter for fetal medicine.

If you or someone you know is facing a complex prenatal diagnosis, it’s important to consult with a specialist in fetal medicine to discuss all available options. Advances in this field are helping babies around the world lead healthier, fuller lives from the moment they are born. Contact Shukan Hospital & IVF Centre today to schedule a consultation and explore the best treatment options for your baby’s health and future.

Author bio

Dr. Payal Patel

She is a highly respected and dedicated Obstetrician, Gynecologist, and Infertility Specialist with over 6 years of experience in women’s healthcare. At Shukan Hospital & IVF Centre, she has earned a reputation for her expertise in managing complex gynecological issues and providing comprehensive infertility treatments. She is known for her patient-centered approach, ensuring that each patient receives the best possible care tailored to their unique needs. Her compassionate nature and commitment to staying updated with the latest advancements in her field make her a trusted advisor and healthcare provider for many women.

FAQs

What are the eligibility criteria for fetal surgery?

Fetal surgery is only recommended for certain conditions, and eligibility depends on factors like the gestational age of the fetus, the severity of the condition, and the health of the mother.

How long does recovery take after fetal surgery for the mother and baby?

Recovery times vary depending on the type of fetal surgery, but mothers typically require close monitoring for the remainder of the pregnancy. Babies will be monitored after birth to ensure the surgery was successful.

Can fetal surgery be performed in cases of multiple pregnancies (triplets or more)?

Fetal surgery is more complicated in cases of multiple pregnancies and is usually considered on a case-by-case basis, depending on the specific condition affecting one or more of the fetuses.

What are the chances of preterm labor after fetal surgery?

Preterm labor is a common risk associated with fetal surgery, particularly with open procedures. The risk can be managed with medications and careful monitoring throughout the pregnancy.

Are there alternative treatments if fetal surgery is not an option?

If fetal surgery is not feasible, some conditions can be managed after birth with neonatal surgery or supportive care, although outcomes may vary.

How is the mother’s health monitored during and after fetal surgery?

Maternal health is closely monitored through regular ultrasounds, blood tests, and physical assessments to manage risks like infection or preterm labor.

Is fetal surgery covered by insurance, and what is the cost involved?

The cost of fetal surgery can be high, and coverage depends on the health insurance plan and the specific condition being treated. Families should consult with their healthcare providers and insurers to understand potential costs.