History

• The first blood transfusion to a fetus took place in the 1960s, but it wasn't until 1980 that fetal surgery was discovered. It was developed through the experimental use of animals at the University of Californnia in San Francisco. It was in 1981 that the first human fetal operation took place. Dr. Michael Harrison is credited with having performed the first fetal surgery. The fetus was diagnosed with congenital hydronephrosis, a condition in which bloating of the renal pelvis causes a blockage, resulting in the inability of urine to flow freely from the kidneys. As a result, the kidneys atrophy or completely waste away. Through the fetal surgery Dr. Harrison performed, the condition was corrected and the baby survived.
  
  

Significance

• Fetal surgeries have saved the lives of thousands of babies by correcting life threatening congenital abnormalities. They are performed when there is no other way for the fetus to survive until its delivery or when it has been determined that the abnormality would become too severe to treat after delivery. Fetal surgeries enable the doctor to alleviate the problem long enough for the fetus to continue developing in utero so that it is strong enough to survive a more extensive surgery once it has been delivered.
  
  

Function

• Congenital abnormalities are usually discovered through an ultrasound around the twentieth week of gestation. Once an abnormality has been located, the doctor will determine if the fetus can survive with it until the date of delivery, or if it is severe enough to warrant fetal surgery. If fetal surgery is required, the doctor will then determine what type of fetal surgery is necessary. There are surgeries that are considered invasive others minimally invasive. The type of fetal surgery performed is dependent upon the severity of the abnormality.
  
  

Types

• There are three main types of fetal surgeries. The first and most invasive is open fetal surgery. This type is very similar to a Ceasarean section, as an incision is made in the mother's abdomen and the fetus is partially removed. During the surgery, the fetus is receiving its life support through the placenta while the surgeon repairs the detected abnormality. Upon completion, the baby is placed back in the uterus to continue developing. The risks for premature birth are high in this case, and so the mother is often given medication to prevent the onset of labor. The second type of fetal surgery is known as fetendo surgery. While not quite as invasive, it still poses a risk for pre-term labor. In this surgery, the doctor will use video imagery as he inserts surgical instruments into the uterus, correcting the abnormality. Finally there is fetoscopic surgery, which is the least invasive form of fetal surgery. It is performed by creating a small opening in the mother's abdomen, yet requires no incision into the uterus, nor does it require an endoscopic view in the uterus. The doctor is guided by an ultrasound, helping him locate the abnormality. Fetoscopic fetal surgery poses little or no risk for pre-term labor.
  
  

Considerations

• Once the parents have been informed of their options, they must take many things into consideration before making a decision. First, the mother will experience discomfort from the surgery and will most likely be placed on bed rest for the remainder of her pregnancy to decrease the risk of pre-term birth. If there are other children at home, the parents will need to rely on a support group of friends and family to assist the mother with the care of these children. And while most fetal surgeries are successful, the parents must realize it is only a temporary treatment until the baby is born. It will then need to undergo further surgery to remove the abnormality, whether that be a tumor or surgery to further correct spina bifida. They must also consider that a successful fetal surgery may not result in the survival of the baby once it is born. It is simply an interim treatment until the child is delivered.
  
  

Warning

• There are risks involved with fetal surgery, although these risks are more to the fetus than the mother. The risks involved during fetal surgery include excessive bleeding, infection and premature birth. If an open fetal surgery is performed, it will be necessary for the mother to have a Ceasarean section for the birth of the baby due to the incisions made into the abdomen and uterus. This also means future Ceasarean sections for subsequent births. The doctor will explain any and all risks associated with fetal surgery, but if you have any questions, ask them. It is crucial to make your decision with all of the potential dangers presented to you.