Open Maternal Fetal Surgery

Open Maternal Fetal Surgery at UNC Health

In rare situations, open maternal fetal surgery is performed when operating on the baby while still in the womb can improve the outcome for the baby. The most common reasons to perform open maternal fetal surgery is to repair fetal spina bifida, or to remove a life-threatening fetal tumor. Fetal tumors include lung or chest masses or sacral tumors that are causing heart failure in the baby at a gestational age where delivery is not possible.

Open maternal fetal surgery involves making an incision in the mother’s abdomen, then the uterus (womb), to expose the baby. The baby is not delivered but remains in the uterus and receives oxygen and blood across the placenta. Once the procedure is completed, the uterus is closed and the baby is allowed to continue developing in the womb. This procedure requires a highly skilled and collaborative team of high risk obstetric providers from the division of Maternal-Fetal Medicine, pediatric surgeons, and obstetric trained anesthesia providers among others.

During the procedure, which may last two hours, the mother undergoes general anesthesia and a skin incision similar to a cesarean delivery is performed. A hemostatic incision is made in the uterus while medications are given to maintain uterine relaxation, with care being taken to not disturb the placenta. Oxygen and anesthesia continue to pass to the fetus via the placenta and umbilical cord. The maternal-fetal medicine physician performs the uterine incision and fetal positioning and monitors the fetal heart with ultrasound during the procedure.

In the case of a fetal spina bifida the fetus is then positioned to expose the spina bifida at the uterine incision and the neurosurgeon closes the defect.

Amniotic fluid is then replaced, and the uterine incision is closed. The mother is usually in the hospital for 3-6 days following the surgery and receives medication to reduce the risk of preterm  labor. After discharge from the hospital, reduced maternal physical activity and weekly follow up is planned. Delivery is then performed by cesarean delivery at 37 weeks, ideally prior to the onset of labor.