Fetal intervention is a treatment, surgery or procedure performed on a fetus while it is still in the uterus. There are several different types of fetal interventions that may be performed in response to certain congenital abnormalities or conditions. These conditions may include congenital heart disease and an opening in the spine known as spina bifida. Surgeries for fetal intervention can range from very minimally invasive to extremely invasive in nature. The mother is more at risk with certain types of intervention than with others.
Open fetal surgery is a highly invasive fetal intervention that involves opening up the mother's lower abdomen and uterus to gain access to the fetus. This requires general anesthesia for the mother so that she is asleep during the entire procedure. After the abdomen and uterus have been opened, the necessary fetal repair or preventative measures are taken and both are then closed. Often the mother must remain in the hospital for several days for observation and treatment of post-surgery contractions.
Ex Utero Intrapartum Treatment (EXIT) is a type of fetal intervention that takes place when the baby is ready to be delivered. Typically it is performed when the baby has an obstructed airway that will prevent it from being able to breathe properly once it is separated from the placenta. It involves a Cesarean, however, like the open fetal surgery the mother is put under using general anesthesia. The baby is then partially delivered but not separated from the umbilical cord until after the airway has been successfully cleared. Once the surgeon is assured that the baby can breathe, it can then be fully delivered.
Fetoscopic intervention, or fetendo fetal surgery, is a less invasive procedure that frequently takes the place of open fetal surgery for certain types of congenital conditions. Unlike open fetal surgery, there is no need to open up the abdomen or the uterus, although the mother is typically asleep for the procedure. This type of fetal intervention is performed in utero and involves putting tubes through the mother's abdominal wall and the uterine wall. Instruments and a telescope are inserted through those tubes to perform the surgery. The surgeons performing the fetoscopic intervention are guided by live, real-time images provided by the telescope and a sonogram.
The least invasive procedure for fetal intervention is called Fetal Image-Guided Surgery (FIGS-IT). It is performed using a sonogram for a real-time image of the fetus. This surgery involves only the insertion of a needle through the mother's abdomen, the uterine wall and into the fetus. Regional or local anesthesia is typically all that is required for this type of intervention, however in rare cases general anesthesia may be necessary. Preventative treatments that may involve fetal image-guided intervention may include blood sampling or placing catheters in the bladder, but generally it is not used for more complex intervention where surgery is necessary.