Children's Hospital Colorado
Colorado Fetal Care Center
Colorado Fetal Care Center

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Open Fetal Surgery

Fetal surgery is a multidisciplinary approach to repairing fetal conditions or complications that develop during pregnancy. This kind of surgery requires expert level care and state-of-the-art technology to ensure the best possible outcomes for a mother and her unborn baby. At Colorado Fetal Care Center, we offer world-class open fetal surgery catered to each specific patient.

Over the past decade, our prenatal fetal surgery team has developed nationally-recognized surgical processes and techniques to intervene in even the most serious 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 clinic is ready to act in cases of life-threatening situations, we also provide surgical treatment options for conditions myelomeningocele and a variety of neonatal tumors.

At Colorado Fetal Care Center, families benefit from the vision, innovation and discipline of a dedicated group of committed surgeons, maternal fetal medicine specialists and anesthesiologists.

What is open fetal surgery?

Open fetal surgery is a unique operative procedure that requires general anesthesia for the mother. The anesthesia relaxes the uterus and passes through the placenta to the unborn child, allowing the fetal surgery team to perform necessary procedures without interfering with the pregnancy.

Fetal surgery would not have been possible without recent advancements in prenatal imaging, disease progression, and surgical technology.

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 over developing neural tissue during pregnancy. Research shows that this will prevent further neural damage and cerebrospinal fluid leak.

A mother whose baby is diagnosed with open spina bifida defects may meet predetermined inclusion criteria based on the Management of Myelomeningocele (MOMs) study. Our fetal care team will consult your baby’s individual condition before deciding on a course of action.

Removal of large congenital pulmonary airway malformation lesions

Congenital pulmonary airway malformation (CPAM) is a benign congenital cystic lung lesion of pulmonary tissue with proliferation of bronchial structures. CPAMs occur during the early stages of fetal lung development but grow rapidly in the second trimester (around 20 weeks' gestation).

Open fetal surgery may be considered when there are predominantly solid large lung lesions associated with fetal hydrops and mediastinal shift found prior to 32 weeks' gestation. Before opting for open fetal surgery, the mother will be assigned at least one or two courses of steroid medication to ensure the lesions don’t resolve.

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. 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 do I prepare for prenatal surgery?

After meeting with our multidisciplinary team, our nurses will provide you with instructions regarding fasting for 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 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 are the risks of fetal surgery?

Once the procedure is complete, the fetus is returned to the uterus for the remainder of the pregnancy. You will be an inpatient at our maternal fetal care unit for approximately 5 days after the fetal procedure. During this time, you will be watched for signs of uterine contractions, as well as signs of premature membrane rupture. Depending on the reason for your fetal operation, you need a follow-up ultrasound and MRI.

After discharge, you and your family will need to stay close to the hospital until your fetal team gives you clearance to travel further. This means temporarily relocating to Denver if you live more than 30 minutes from Children's Hospital Colorado.

You will have a follow-up appointment that may entail a repeat ultrasound and/or an MRI to evaluate your baby's responses. You will also be given instructions for modified bed rest, which you'll need to maintain for the rest of your pregnancy. When you return home, you'll be given contact information for our team to ensure all your questions are answered quickly.

When the time comes to deliver your baby, you'll return to Children's Colorado for delivery by C-section. 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.

Additional resources

Learn more about our national studies involving open fetal myelomeningocele research and 3D printing for treating spina bifida research.