Fetal Surgery

Fetal surgery (also called in-utero or intrauterine surgery) refers to surgery performed on the baby or placenta in the womb, prior to birth.  It is most commonly used in the treatment of some complications of twin pregnancies, and may also be used in the treatment of some birth defects.

The conditions most commonly treated by fetal surgery include:

• Twin-twin transfusion syndrome
• Acardiac twins
• Other monochorionic (single placenta) twin complications
• Spina bifida
• Congenital diaphragmatic hernia
• Congenital cystadenomatoid malformation of the lung (CCAM)
• Congenital heart defects
• Sacrococcygeal teratoma

Around the world, surgeons have explored the option of intrauterine surgery for several decades, however this highly specialised area of medicine is still in its infancy, and treatments are continually evolving.

Thankfully the number of babies that have conditions in which fetal surgery may be an option is quite small.  For those small number of babies, fetal surgery may increase their chances of surviving the pregnancy and newborn period, or may improve their quality of life.  It is important to recognise though that fetal surgery is not always successful, and may in fact pose some significant risks for both the mother and her unborn baby.  Those risks need to be balanced against the potential benefits of the procedure.

The evaluation of a patient who may potentially benefit from fetal surgery is complex and highly specialised, and can only be performed by an experienced fetal surgeon. Not only does the condition itself require thorough evaluation, but the potential complexity of the procedure and risks to mother and baby need to be considered.  Sometimes even relatively subtle differences in circumstances can make a big difference in the feasibility or likely success of a procedure.  

If you have a condition that you think, or that you have been told may benefit from fetal surgery, you should certainly do your own research to try and understand as much as you can about the condition, and potential treatment options.  But it is important to remember that this is not a substitute for individualised, considered evaluation by an expert.

In Victoria fetal surgery is performed by the Victorian Fetal Therapy Service (VFTS).  The VFTS was established in 2006 as a collaboration between the three major obstetric hospitals in Melbourne - The Royal Women's Hospital, Monash Medical Centre, and Mercy Hospital for Women.  A small number of dedicated obstetric surgeons from each of those hospitals work collaboratively to provide high quality fetal surgical options for those women who may benefit from this approach.  If you potentially require fetal surgery in Victoria, you will be referred to one of these surgeons.  I have been one of the teams involved in the planning and establishment of the VFTS, and continue as a member of the surgical team.  I am happy to meet with you and discuss the role of fetal surgery in your situation, including feasibility along with the potential benefits and risks of surgical and non-surgical approaches.

Frequently Asked Questions

What type of doctor does fetal surgery?

Fetal surgery is a cross-disciplinary practice that covers a range of specialisations. Procedures are often conduct

ed by obstetricians, pediatric surgeons or perinatologists, with surgical teams often containing a mix of specialists. Dr Stephen Cole is an experienced practicing obstetrician and a founding member of the Victorian Fetal Therapy Service – fetal surgery is an area of specialised interest and deep research for him, and he welcomes the opportunity to consult with you regarding your pregnancy. 

How is intrauterine surgery performed?

Intrauterine surgery can be conducted using a variety of techniques, with each patient’s unique circumstances and anatomy influencing the outcome. Broadly, fetal surgery is conducted either as open surgery, in which the uterus is completely opened to access the fetus; or as fetoscopic surgery, a minimally-invasive laparoscopic approach. Dr Cole will advise which procedure best suits your and your baby’s needs. 

Does fetal surgery hurt the baby?

Any procedure presents a risk of complications, including fetal surgery. These risks will be carefully balanced against the possible benefits of the procedure, with a decision only made to proceed where Dr Cole is satisfied that there is a likely chance of success and minimal risk of harm to both parent and child. 

What happens to the amniotic sac during fetal surgery?

In all surgical interventions, care is taken to preserve the amniotic sac as much as possible. Minimally invasive procedures allow most of the fluid within the amniotic sac to be preserved. 

What is a Fetoscopic surgery?

Fetoscopic surgery is a minimally-invasive alternative to open fetal surgery. Through the use of specialised tools and imaging devices, surgery can be conducted on a fetus without the need to completely open the uterus, resulting in a shortened healing time for the parent and a reduced risk of complications.