What is fetal surgery
and when is it indicated during pregnancy?
The vast majority of pregnancies proceed without complications and result in the birth of healthy babies. However, in a small percentage of cases, congenital anomalies or conditions that could threaten a baby’s life or development are detected before birth. When this happens, a timely intervention can make a significant difference.
Thanks to advances in fetal medicine, there are now procedures that allow for the treatment of certain conditions during pregnancy. Although these highly specialized interventions are reserved for very specific cases, they have changed the prognosis for conditions that, just a few decades ago, offered very few treatment options.
What is fetal surgery?
Fetal surgery is a branch of maternal-fetal medicine that allows for the treatment of certain conditions before a baby is born.
These procedures are performed using minimally invasive techniques. Using small instruments guided by ultrasound and endoscopy, specialists perform procedures without removing the baby from the uterus, reducing the impact on both the mother and the fetus.
Advances in surgical techniques, the development of multidisciplinary teams, and the growing expertise of specialized centers have resulted in reduced risks associated with the procedure and enable shorter surgical times and faster recoveries for the mother.
“I wouldn’t speak of inherent risks… there are practically none,” explains Dr. Eduard Gratacós, an international leader in fetal medicine at the Hospital Sant Joan de Déu, in Barcelona. “The greatest challenges are not in the procedure itself, but the severity of the condition being treated.”
When is fetal surgery indicated?
Fetal surgery is a branch of maternal-fetal medicine that allows for the treatment of certain conditions before a baby is born.
These procedures are performed using minimally invasive techniques. Using small instruments guided by ultrasound and endoscopy, specialists perform procedures without removing the baby from the uterus, reducing the impact on both the mother and the fetus.
Advances in surgical techniques, the development of multidisciplinary teams, and the growing expertise of specialized centers have resulted in reduced risks associated with the procedure and enable shorter surgical times and faster recoveries for the mother.
“I wouldn’t speak of inherent risks… there are practically none,” explains Dr. Eduard Gratacós, an international leader in fetal medicine at the Hospital Sant Joan de Déu, in Barcelona. “The greatest challenges are not in the procedure itself, but the severity of the condition being treated.”
When is fetal surgery indicated?
Fetal surgery is considered when the baby’s life, or quality of life after birth, could be seriously compromised if no intervention takes place. According to Dr. Gratacós, these are complex conditions that require careful evaluation to determine whether a prenatal intervention can offer a real benefit.
Because these cases are rare and require highly specialized teams, only a small number of international centers have the necessary bandwidth in experience and infrastructure.
Conditions that may benefit from fetal therapy include:
❂ Feto-fetal transfusion syndrome in twin pregnancies
❂ Congenital diaphragmatic hernia
❂ Spina bifida (in selected cases)
❂ Certain fetal lung diseases
❂ Severe fetal anemia
Each case requires an individual assessment to determine whether the benefits of the procedure outweigh the risks.
In some cases, fetal intervention completely corrects a problem, and the pregnancy can continue normally. In others, surgery does not replace the treatment the baby will need after birth, but it does significantly increase the baby’s chances of survival while improving the prognosis.
Successful intervention depends on the medical team’s experience, the availability of highly specialized neonatal care, and coordination across all stages of treatment—from prenatal diagnosis to newborn care.
Why Can International Access Make a Difference?
Conditions requiring fetal surgery are rare and highly complex. As a result, access to treatment remains limited. Although there are centers that offer fetal therapy, not all have the same level of experience, technology or case volume—factors that can influence outcomes. In addition, the cost for these highly specialized procedures can be very high, making access even more difficult for many families.
Compounding this issue is the fact that, for many of these conditions, there is a limited window of opportunity to evaluate the case and determine whether prenatal intervention will improve the baby’s prognosis. Acting quickly is essential, as delaying evaluation by a specialized team limits treatment options. Referral centers have processes in place that allow for reviewing imaging studies remotely, conduct a multidisciplinary evaluation within a few hours, and, when the case requires it, organize a quick intervention.
Having international health insurance can make a significant difference. In addition to facilitating access to hospitals and specialists with extensive experience in fetal medicine, it provides the support of a team that helps coordinate authorizations, transfers and treatments when every day counts for the mother and baby’s health.
