Fetal Interventions: What Is Possible Today

Fetal intervention, which is surgery to treat your baby before birth, is a highly specialized field of medicine that has evolved over several decades of intensive medical research and advances in technology.

At High Risk Pregnancy Doctors, we combine our extensive experience with the most sophisticated technology available so we can detect and treat fetal problems at the earliest possible stage. For example, we perform first trimester fetal echocardiography, detecting heart conditions as early as 11 weeks after conception.

Though it’s hard to imagine ever needing to consider a fetal intervention, if you’re faced with that decision, you can rely on having all the information you need and compassionate guidance from maternal-fetal medicine specialist Violetta Lozovyy, MD.

It also helps to understand the possibilities, so we created this blog to give you an inside look at a few of the fetal interventions available today.

Advances in fetal diagnostics and interventions

The path to today’s fetal interventions began with amniocentesis, giving doctors the ability to diagnose congenital problems before birth. Then the field took a giant step forward with fetoscopy, which allows high-risk pregnancy specialists to see inside the uterus, obtain tissue samples, and perform surgery using a narrow endoscope.

The first fetal interventional procedure was a transfusion of red blood cells. Then in 1981, the first fetal surgery was performed to repair fetal obstructive uropathy, which is a blockage in the urinary tract.

Since then, experts in the field reached many milestones as doctors continued to expand and improve fetal intervention techniques, and tech companies improved diagnostic imaging and developed new minimally invasive tools.

There are too many milestones to cover, so let’s jump ahead to the fetal intervention procedures we can perform today.

Fetal intervention procedures

Taking a quick look at some of the fetal interventions available today is a great way to highlight the amazing possibilities for treating your unborn baby. Fetal intervention procedures fall into four categories: percutaneous procedures, fetal endoscopic surgery, open fetal surgery, and fetal interventions at the time of your delivery called EXIT procedures.

Percutaneous fetal procedures

These procedures are performed using a needle-like instrument and ultrasound to guide the needle as we insert it into your womb. We can use a percutaneous procedure to place a shunt and perform radiofrequency ablation or cordocentesis.

A shunt placed in the chest or urinary tract treats fetal conditions such as urinary tract obstructions, pleural effusion, and cysts in the baby’s chest.

Radiofrequency ablation allows us to block blood flow when needed to treat twin-to-twin transfusion syndrome (TTTS) and severe intrauterine growth restriction.

Cordocentesis allows us to administer medication or give the baby a blood transfusion.

Fetal endoscopic surgery (Fetendo)

Fetendo, or fetoscopy, is performed using a narrow endoscope, a device that contains lighting and a camera that transmits images to a monitor. We can insert this device using a small incision, which avoids the need for open surgery.

Fetoscopy is most often performed to treat twin-to-twin transfusion syndrome, twin-reversed arterial perfusion syndrome (TRAP), amniotic band syndrome, and congenital diaphragmatic hernia.

One example, fetoscopic tracheal occlusion, is a reversible procedure to treat congenital diaphragmatic hernia. Temporarily blocking the trachea with a medical-grade balloon or clip solves the problem by accelerating lung growth. We can also perform fetoscopy to disconnect abnormal blood vessel connections with a laser.

Open fetal surgery

We may recommend open surgery to treat disabling and life-threatening conditions such as neural tube defects. Though we have advanced tools, such as a specialized device that helps prevent bleeding, open fetal surgery is still a complex and risky procedure.

Women are carefully monitored after the surgery. You may need to modify your activity and take medications to prevent preterm labor for the rest of your pregnancy.

EXIT (ex-utero intrapartum therapy) procedures

EXIT procedures are performed as part of a carefully planned, specialized delivery. We may recommend an EXIT procedure to treat airway obstructions, remove a tracheal balloon or clip, remove a mass in the airway, and repair severe congenital heart disease or congenital diaphragmatic hernia. An EXIT procedure can also be used to separate conjoined twins.

During an EXIT procedure, the baby is partially delivered but not separated from the placenta. This allows us to perform diagnostic and therapeutic procedures, such as opening a blocked airway, before fully delivering your baby.

If you have any questions about fetal interventions, or you would like to schedule an appointment, call High Risk Pregnancy Doctors or request an appointment online.


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