Fetal Treatment Program of New England
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Fetal intervention refers to the techniques used to treat a fetus inside the uterus. Although many diseases and conditions can be diagnosed before birth with imaging and genetic tests, very few actually require intervention. If we determine that your baby would benefit from intervention, we will explain all of the options and their benefits and risks.
If you decide to have fetal intervention, our most important consideration becomes your health. While the goal of any fetal intervention is to treat the fetus, to do so requires access to the uterus and this may present varying degrees of risk for you. If the uterus is accessed through surgery, particularly open fetal surgery where an incision is made, there are anesthetic and surgical risks. If the uterus is accessed through a needle or other fine instrument, the risks are much lower. It’s our team’s responsibility to ensure your well being first.
There are three fetal intervention techniques:
- Fetal Image Guided Surgery. Fetal image guided surgery (FIGS) uses sonogram imaging to guide intervention to the fetus, without an incision or endoscopic view inside the uterus. FIGS is performed through the skin or, in some cases, through a small opening in the abdomen. Performed under regional or local anesthesia, FIGS is the least invasive intervention technique, requiring less time in the hospital and causing little discomfort. However, because the uterus membrane is punctured as part of the procedure, there is a risk of preterm labor, so monitoring and medications are often needed until delivery. FIGS is typically an outpatient procedure but may require overnight admittance to monitor for preterm labor.
- Fetoscopic Surgery. This type of intervention (also called “fetendo”) was developed to avoid making an incision in the uterus, and thereby, minimizing preterm labor. Fetendo is performed through either the skin or a small opening in the abdomen, and uses endoscopic and sonographic-guided images to visualize the fetus. Performed under regional or general anesthesia, this procedure is less invasive than open surgery, resulting in easier postoperative recovery. Preterm labor is a risk, so monitoring and medications are still necessary. Recovery typically requires a one to two day hospital stay.
- Open Fetal Surgery. Open fetal surgery is the most invasive type of intervention. Performed while the mother is under general anesthesia, an incision is made into the lower abdomen to expose the uterus, which is then opened with a stapling device used to prevent bleeding. Once the surgical repair of the fetus is complete, the uterus and maternal abdominal wall are closed and the mother is awakened. Open fetal surgery is major surgery and no different than any intro-abdominal operation, such as the removal of a gall-bladder or Cesarean section, except that the mother remains pregnant at the end of the operation. The surgery and recovery require hospitalization for up to a week, as well as Cesarean delivery of this and future pregnancies. Because an incision has been made in the uterus itself mid-gestation, open fetal surgery can lead to preterm delivery, so the mother will require close monitoring and medications to manage preterm labor.