Fetal intervention is the process of performing surgery on a fetus (unborn baby) in the uterus. This is done for improving the long-term outcomes of the children who have specific birth defects. As the fetus develops, these defects can get worse. At the Rainbow Children’s Heart Institute, we have a team of experts that is focused on improving and treating your child before birth.
The Rainbow Children’s Heart Institute, we offer a comprehensive fetal intervention that includes the following:
- Amniotic band resection
This procedure involves dividing up the Amniotic bands that are constricting the extremities like the umbilical cord and are threatening amputation. A fetoscope and ultrasound are used for identifying the band and dividing them with laser or surgical instruments.
- Ex-Utero Intrapartum Treatment (EXIT)
This is the EXIT procedure that is a specialized fetal operation occurring at the time of the birth. Carried out on fetuses with rare conditions that might cause problems immediately after birth.
- Fetal shunt placement
In this ultrasound-guided fetal intervention procedure, a shunt (tube) is placed in the fetus’ abdomen for connecting the amniotic cavity to the bladder. This is done for draining the blocked urine.
- Fetoscopic Laser Photocoagulation for TTTS
This is a surgical procedure in which a fetoscope (a tiny camera) is used for locating blood vessel connection which is not normal. It also includes treating the issue by using laser energy for sealing the abnormal connections.
- Intrauterine Transfusion
This is an ultrasound-guided fetal intervention in which a needle is inserted into the fetal abdomen or the umbilical cord. Then, blood is transfused to the baby for treating severe anemia.
- Umbilical coagulation or Radiofrequency ablation for complicated monochorionic pregnancies
- This fetal intervention is highly-selective and rare. This is done for twin pregnancies when there is a concern for twin’s health or life. In such cases, bipolar energy or radiofrequency waves are used for interrupting the blood flow to the affected twin. An example of this procedure is the TRAP sequence where the pump twin’s life is in imminent danger.
- What birth defects can be treated through fetal intervention?
The following conditions can be treated through fetal intervention:
- Fetal anemia
- Neck mass
- Amniotic band syndrome
- Congenital high airway obstruction syndrome (CHAOS)
- Congenital diaphragmatic hernia (CDH)
- Congenital cystic adenomatoid malformation (CCAM)
- Twin-Twin Transfusion Syndrome (TTTS)
- Twin Reversed Arterial Perfusion (TRAP) sequence
- Twin Anemia-Polycythemia Sequence (TAPS)
- Mediastinal teratoma
- Bronchopulmonary sequestration of the lung
- Myelomeningocele (Spina Bifida)
- Sacrococcygeal Teratoma (SCT)
- Lower Urinary Tract Obstruction (LUTO)
- What are the different surgeries included in the Fetal Intervention?
Here are the surgeries included in the Fetal Intervention:
- Bipolar cord coagulation for TRAP sequence
- Ex-Utero intrapartum treatment (EXIT)
- Fetal cardiac intervention
- Fetal vesicoamniotic shunt (VAS) and fetal cystoscopy for bladder obstruction
- Fetoscopic endoluminal tracheal occlusion (FETO) for severe CDH
- Fetoscopic laser ablation for TTTS and TAPS
- In utero open or fetoscopic repair of myelomeningocele
- Intrauterine blood transfusion
- Open fetal surgery for SCT resection
- Open fetal surgery to remove CCAM of the lung
- Radiofrequency ablation for fetal tumors
- Serial amnioinfusion for complex renal diseases and bilateral renal agenesis
- Shunt placements
- Why is Fetal Intervention important?
Implementing fetal intervention before the baby is born can help in treating life-threatening birth defects and improving outcomes. Also, the results of the fetal intervention are better than performing surgery after the baby is born. The importance of Fetal Intervention can be explained more and better by cardiology specialist in hyderabad or best heart surgeon in hyderabad
- Are there any risks involved in Fetal Intervention?
Like any other surgery, there are risks involved in Fetal Intervention as well. Also, the risks will be to you as well as your unborn baby. Some examples of risks include fetal death, uterine rupture, early labor, operative complications, and failure to treat the defect.
- What are the different techniques used for fetal intervention?
There are four major approaches to fetal intervention:
- Open fetal surgery
This is the most invasive and most definitive form of fetal intervention. During the procedure, the first step is administering anesthesia to the mother. After this, an incision will be made in the lower abdomen to expose the uterus. Then, a special stapling device will be used for opening the uterus and preventing the bleeding. After the surgical repair is done on the fetus, the uterus and the abdominal wall of the mother are closed. This procedure is similar to the Cesarean section. After the surgery, the mother would have to stay in the hospital for 5 to 7 days. Also, an obstetrician will be closely monitoring the pregnancy for preterm labor. Some medications can be given for controlling preterm labor.
- Fetendo Fetal Surgery
Fetendo is the ability of seeing and intervening on the fetus by using small endoscopes. Surgical scopes now have the ability to manipulate the fetus using small instruments. The whole procedure is guided through a direct fetoscopic view on the monitor. The name of the procedure is as such because it is similar to playing a video game. The best way to see the fetus is by combining sonographically-guided manipulation and image-guided manipulation.
This procedure can be performed through the mother’s skin as well as through a small opening in the abdomen of the mother. It is less invasive than open fetal surgery and the postoperative recovery is comparatively easy.
- Fetal Image-Guided Surgery (FIGS-IT)
This is a procedure in which the fetus is manipulated without an endoscopic view of the uterus or an incision in the uterus. The manipulation is carried out through a real-time cross-sectional view from the sonogram. This is the same sonogram used for visualizing the fetus throughout the pregnancy. It can be done through the skin or a small incision in the abdomen of the mother. This is the least invasive fetal intervention technique. The risk of preterm labor is reduced. However, preterm labor medications and monitoring will still be required.
- EXIT procedure
This form of intervention is performed at the time of the delivery. It is used in cases where the airway of the baby is compromised and they need assistance for breathing. This is a specialized delivery involving baby and the mother. The procedure starts with a cesarean section. After the head of the baby is delivered, a bronchoscope is used to look at the airway inside the baby’s mouth. This is done before separating the baby from the placenta. Depending on the condition, the doctor will proceed with the intervention.
- Open fetal surgery