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Open Fetal Surgery During Pregnancy

Open fetal surgery in the middle of pregnancy is performed for spina bifida, large chest masses that cause hydrops, and a vascular SCT that causes hydrops. Maternal general anesthesia is required for open fetal surgery. A breathing tube is inserted and the mother remains completely asleep during this procedure. General anesthesia is required to relax the uterus and maintain placental blood flow to the fetus during surgery. Additional medication is if given to relax the uterus as needed. The mother is carefully monitored, and her blood pressure is maintained with medicine and fluid to keep blood flow adequate to the placenta.

A maternal abdominal wall incision is made and the uterus is exposed. A classical Cesarean incision is performed away from the placenta. A special hemostatic stapling device is used to control bleeding from a relaxed uterus. In addition to the anesthesia that crosses the placenta, the fetus receives an injection of medicine for anesthesia. The fetus is monitored with a pulse oxymeter (which monitors heart rates and oxygen saturation) and continuous fetal echocardiogram by a pediatric cardiologist. The uterus is infused with warm saline solution to maintain relaxation, prevent placental separation, and avoid umbilical cord compression. The fetal operation is performed with the fetus partially outside the uterus. After the fetal operation, the fetus is placed back into the uterus, fluid is instilled, and the uterus and maternal abdominal wall are closed. The mother is given medication to prevent preterm labor, and she and her baby are closely monitored in the hospital. Once maternal and fetal well-being is assured, the mother may be discharged and followed closely as an outpatient.

Learn about Open Fetal Surgery at the End of Pregnancy.