The most invasive form of fetal therapy involves an incision into the uterus to allow access for our multidisciplinary team to operate on the fetus while still in the womb.  After the surgery is completed, the uterus is closed and the pregnancy continues to deliver later in pregnancy.

Open fetal surgeries include:

• Fetal myelomeningocele (fetal surgery for spina bifida)
• Resection of large sacrococcygeal teratoma
• Congenital pulmonary airway malformation (CPAM) causing heart failure and not responding to medical treatments

This less invasive approach uses a very small incision in the uterus to allow entry of a small fetoscope into the womb through which a camera and small instruments can be used to perform surgery.

Minimally invasive fetoscopic surgeries include:

• Twin to Twin Transfusion Syndrome (TTTS), fetoscopic laser ablation of communicating vessels (laser ablation)
• Amniotic band excision, fetoscopic

For the 5% of fetal congenital heart diseases that are considered critical, intrauterine intervention may be necessary.  This is a fetal heart surgery using a percutaneous (through the skin) approach to correct defects prior to birth.

Fetal cardiac surgeries include:

• Aortic valvuloplasty or pulmonary valvuloplasty for aortic or pulmonary stenosis
• Atrial septostomy for intact atrial septum

This is the least invasive approach and involves using ultrasound to guide the placement of needles, catheters, shunts, or balloons which can be used for a variety of fetal therapies.

Percutaneous fetal surgeries include:

• Bladder (vesicoamniotic) shunt placement
• Chest, (thoracoamniotic) shunt placement for pleural effusions or macrocystic CPAM
• Complicated monochorionic diamniotic pregnancy therapies
• Twin reverse arterial perfusion syndrome (TRAP) therapy
• Complicated monochorionic monoamniotic twin therapies
• Intrauterine fetal blood sampling (cordocentesis) and intrauterine blood transfusions

This is a specialized cesarean delivery performed at the time of birth. The baby is partially delivered and left attached to the placenta. The operating team of specialists performs needed procedure on the baby to allow the safest transition to life outside the womb. The EXIT procedure is most often used when there is a problem expected with the baby being able to breath at the time of birth.