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Fetal Surgery: Principles, Indications, and Evidence

Wenstrom, Katharine D. MD; Carr, Stephen R. MD

doi: 10.1097/AOG.0000000000000476
Contents: Clinical Expert Series
Expert Discussion
Spanish Translation

Since the first human fetal surgery was reported in 1965, several different fetal surgical procedures have been developed and perfected, resulting in significantly improved outcomes for many fetuses. The currently accepted list of fetal conditions for which antenatal surgery is considered include lower urinary tract obstruction, twin–twin transfusion syndrome, myelomeningocele, congenital diaphragmatic hernia, neck masses occluding the trachea, and tumors such as congenital cystic adenomatoid malformation or sacrococcygeal teratoma when associated with developing fetal hydrops. Until recently, it has been difficult to determine the true benefits of several fetal surgeries because outcomes were reported as uncontrolled case series. However, several prospective randomized trials have been attempted and others are ongoing, supporting a more evidence-based approach to antenatal intervention. Problems that have yet to be completely overcome include the inability to identify ideal fetal candidates for antenatal intervention, to determine the optimal timing of intervention, and to prevent preterm birth after fetal surgery. Confronting a fetal abnormality raises unique and complex issues for the family. For this reason, in addition to a maternal-fetal medicine specialist experienced in prenatal diagnosis, a pediatric surgeon, an experienced operating room team including a knowledgeable anesthesiologist, and a neonatologist, the family considering fetal surgery should have access to psychosocial support and a bioethicist.

Fetal surgery can benefit fetuses with specific anomalies, but methods for identifying ideal candidates and preventing preterm birth after surgery have not yet been perfected.Supplemental Digital Content is Available in the Text.

Women & Infants Hospital of Rhode Island, Warren G. Alpert Medical School of Brown University, Providence, Rhode Island.

Corresponding author: Katharine D. Wenstrom, MD, Women & Infants Hospital of Rhode Island, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, 101 Dudley Street, Providence, RI 02905; e-mail: kwenstrom@wihri.org.

Dr. Rouse, Associate Editor of Obstetrics & Gynecology, was not involved in the review or decision to publish this article.

Continuing medical education for this article is available at http://links.lww.com/AOG/A553.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.