If you’re reading about fetal surgery, it’s likely not out of curiosity. You are probably here because something was said in a doctor’s office that changed the way you see your pregnancy and now you’re trying to understand what it means and who can help.
Today, specialized centers across the United States perform hundreds of in-utero procedures each year, intervening before birth to mitigate or improve life-altering conditions that once offered families little to no hope at all. From medication treatment and minimally invasive fetoscopic surgery to open maternal-fetal surgery and EXIT procedures, the scope of fetal interventions continues to expand — a testament to how far fetal therapy has come, and a luminous promise of everything still on the horizon.
Facing fetal surgery can feel overwhelming. This guide walks you through what you need to know about this growing specialty, including what fetal surgery is and who performs it, as well as which conditions are candidates for in-utero treatment and why specialized care matters.
Which conditions are most appropriate or common in fetal surgery?
The most common fetal surgical interventions involve complex monochorionic twin pregnancies diagnosed with twin-twin transfusion syndrome (TTTS), selective fetal growth restriction (sFGR), twin anemia polycythemia sequence (TAPS), and twin reversed arterial perfusion sequence (TRAP). In these cases, twins share a single placenta with blood vessel connections between the two, placing them at risk for serious complications. Intervention is often aimed at separating those shared placental blood vessels using techniques such as laser therapy.
Less common but highly complex procedures include treatment for:
- Fetal spina bifida (fetus has an open defect in the spine)
- Congenital diaphragmatic hernia (CDH) (rare but serious birth defect where an opening in the diaphragm allows abdominal organs to shift into the chest and crowd developing lungs)
- Pleural effusions (fluid collections in the fetal chest)
- Lower urinary tract obstruction (LUTO)
- Fetal anemia
- Fetal lung lesions such as congenital pulmonary airway malformations (CPAM) or bronchopulmonary sequestration (BPS)
- Complex fetal tumors or placental masses
What are the types of fetal procedures, from minimally invasive to open maternal-fetal surgery?
Many fetal procedures are minimally invasive and performed using either a needle or a small camera inserted through the mother’s abdomen and uterus via a very small incision. These procedures are often done using mild sedation and typically require no more than an overnight hospital stay. The majority of maternal-fetal surgery falls into this category, and minimally invasive techniques are associated with decreased maternal and obstetric risk.
Open maternal-fetal surgery is more invasive and remains necessary for certain complex conditions. These procedures involve a laparotomy (abdominal skin incision) for the mother and a larger uterine incision. Open maternal-fetal surgery is required when advanced surgical techniques are needed, such as resection of fetal masses or, in some cases, repair of fetal malformations such as spina bifida.
Each type of fetal intervention carries meaningful risk alongside meaningful hope — which is precisely why these procedures are performed at highly specialized centers, by teams who have devoted careers to mastering them.
What are some of the biggest misconceptions or questions families have about fetal surgery?
Most families come to fetal centers having never imagined they might need fetal surgery. The amount of new information can feel overwhelming. There are clear indications and real risks, and at times decisions must be made without complete certainty. It’s natural for families to feel anxious.
What many do not anticipate is the extent to which the fetal care team, including the fetal interventionalist (a type of highly specialized maternal-fetal medicine physician), prioritizes education, communication, and support. They’re relieved to find their fetal care team walking with them through what is often one of the most difficult periods of their lives.
What happens to the amniotic sac during fetal surgery?
What happens to the amniotic sac during fetal surgery depends on the type of procedure being performed. The amniotic sac is the fluid-filled space that surrounds and cushions your baby throughout pregnancy. In every case, managing the amniotic membranes is one of the most delicate and consequential parts of the procedure.
In open maternal-fetal surgery, the fetal surgeon makes an incision in the mother’s uterus (called a hysterotomy) and amniotic membranes to access the fetus. During the procedure, warmed sterile fluid is continuously infused into the uterus to keep the baby warm, buoyant, and protected. When the surgery is complete, the uterine incision and membranes are carefully closed together using sutures and additional fluid is infused to restore the amniotic fluid volume to normal levels. The abdominal incision is closed, similar to other surgical procedures.
In fetoscopic surgery, the approach is far less invasive. Small ports roughly the size of a pencil eraser are inserted through the uterine wall, creating much smaller openings in the membranes. While this significantly reduces many surgical risks, the membranes still face the same fundamental challenge: unlike most tissues in the body, the amniotic membranes have very limited ability to heal themselves after being punctured or cut.
Is fetal surgery a specialty?
Fetal surgery is one of the most multidisciplinary endeavors in all of medicine. That’s because every fetal intervention is a team effort. In the operating room, the care team is led by maternal-fetal medicine physicians with specialty training in fetal intervention and ultrasound, with support from pediatric surgeons, anesthesiologists, specialized nurses and additional pediatric subspecialists such as neurosurgeons, airway specialists, or pediatric cardiologists. Outside of the OR, the team includes experts in fetal imaging, genetics, and psychosocial support.
Are there advantages to having an integrated team in fetal surgery?
Absolutely. Programs like the Institute for Maternal Fetal Health at Nemours Children’s have worked deliberately to build strong relationships across multiple pediatric specialties to provide the best possible care. Fetal surgery is truly a team effort, and every member plays a vital role in achieving successful outcomes. That collaboration allows Nemours to deliver world‑class, comprehensive care to our patients and their families.
