Fetal surgery utilizes a multidisciplinary approach to diagnosing and treating a number of fetal health conditions or complications that develop during pregnancy. This kind of surgery requires expertise and state-of-the-art technology to ensure the best possible outcomes for both mom and her unborn baby. At the Colorado Fetal Care Center at Children’s Hospital Colorado, we offer world-class open fetal surgery catered to each specific patient.
Over the past decade, our fetal surgery team has developed nationally-recognized surgical processes and techniques to intervene in even the most complex situations. Our goal is to provide a baby with the best chances of survival and to support the expectant mother during her pregnancy.
While our fetal surgery center is ready to act in cases of life-threatening situations, we also provide surgical treatment options for other conditions that cause significant problems after birth, such as myelomeningocele (MMC) and a variety of neonatal tumors.
At the Colorado Fetal Care Center, families benefit from the vision, innovation and expertise of a dedicated group of fetal surgeons, maternal fetal medicine specialists and anesthesiologists.
What is open fetal surgery?
Open fetal surgery is a unique operation that requires general anesthesia for the mother. Anesthesia relaxes the uterus and allows the placenta to keep delivering oxygen to the baby. Anesthesia also passes through the placenta to the unborn child, allowing the fetal surgery team to perform necessary procedures without causing pain or discomfort to the baby.
Fetal surgery would not have been possible without recent advancements in prenatal imaging, enhanced anesthesia techniques, improved surgical capabilities and an understanding of disease progression — all of which you will find at our Center.
When is open fetal surgery recommended?
Spina bifida repair
Open fetal surgery for open spina bifida defects (myelomeningocele and myeloschisis) requires the closure of fetal skin and tissue over the developing spinal cord early during pregnancy. Research shows that fetal repair decreases the need for a shunt and improves movement by preventing further neural damage and cerebrospinal fluid leak.
A mother whose fetus is diagnosed with open spina bifida defects may be eligible for in-utero repair of the defect. Our fetal care team will consult on your baby’s individual condition before deciding on a course of action. Because of our advanced capabilities and experience, we can sometimes perform this surgery on moms who are not eligible for the surgery at other hospitals.
Removal of large congenital pulmonary airway malformation lesions
Congenital pulmonary airway malformation (CPAM) is a benign (non-cancerous) congenital cystic lung lesion or mass that forms in an unborn baby’s lower respiratory tract during development. CPAMs occur during the early stages of fetal lung development but grow rapidly in the second trimester (around 20-28 weeks' gestation).
Before opting for open fetal surgery to treat these lung lesions, we will give moms at least one or two courses of steroid medication to determine if that can stop the growth. If the mass continues to grow despite steroids, we may consider open fetal surgery if there is risk for fetal hydrops and the fetus is prior to 32 weeks' gestation.
Removal of large sacrococcygeal teratomas
Sacrococcygeal teratoma (SCT) is one of the most common congenital germ cell tumors. It is a mass located at the base of the tail bone and occurs in approximately one in every 35,000 births.
Open fetal surgery is offered in these cases to allow for controlled removal of the tumor prior to delivery or at the time of delivery. Surgery is designed to avoid rupture of the teratoma's capsule, which results in significant bleeding and can put both mom and baby at risk.
How to prepare for prenatal surgery
After meeting with our multidisciplinary team, our nurses will provide you with instructions regarding fasting before surgery, when to report to the maternal fetal care unit and pre-operative surgical hygiene.
As a part of our fetal care team's surgical process, you will meet with our multidisciplinary team, including our fetal anesthesiologists, during the consent meeting. During these pre-operative appointments, you will have time to discuss your surgery, pain management and any other questions you may have.
What to expect after open fetal surgery
Once the procedure is complete, the fetus remains in the uterus for the remainder of the pregnancy. You will be an inpatient at our maternal fetal care unit for approximately 4 to 5 days after the open fetal procedure. During this time, we will watch for signs of uterine contractions, as well as signs of premature membrane rupture.
After discharge, you and your family will need to stay close to the hospital until your fetal team gives you clearance to travel farther. This means temporarily relocating to Denver if you live more than 30 minutes from Children's Colorado at Anschutz Medical Campus.
You will have a follow-up appointment that may include a repeat ultrasound and/or an MRI to evaluate your baby's progress. We will provide instructions for modified bed rest, which you'll need to maintain for the rest of your pregnancy. We also provide contact information for our team to ensure all your questions are answered quickly even after you’ve left the hospital.
Delivery after open fetal surgery
When the time comes to deliver your baby following open fetal surgery, you'll be required to deliver by C-section. This can be done at Children’s Colorado or your local hospital if the required specialists are available. The Colorado Fetal Care Center employs extensive planning, multidisciplinary family consultation meetings and follow-up appointments to ensure you get all the support you need before and after open fetal surgery.
Learn more about our national studies involving open fetal myelomeningocele research and 3D printing for treating spina bifida research.