56. Fetal Surgery

  1. John T. Queenan MD3,
  2. Catherine Y. Spong MD4 and
  3. Charles J. Lockwood MD5
  1. Robert H. Ball MD1 and
  2. Hanmin Lee MD2

Published Online: 4 JAN 2012

DOI: 10.1002/9781119963783.ch56

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition

How to Cite

Ball, R. H. and Lee, H. (2012) Fetal Surgery, in Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach, Sixth Edition (eds J. T. Queenan, C. Y. Spong and C. J. Lockwood), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119963783.ch56

Editor Information

  1. 3

    Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC, USA

  2. 4

    Bethesda, MD, USA

  3. 5

    Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA

Author Information

  1. 1

    Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA

  2. 2

    Department of Surgery, Fetal Treatment Center, University of California, San Francisco, CA, USA

Publication History

  1. Published Online: 4 JAN 2012
  2. Published Print: 24 FEB 2012

ISBN Information

Print ISBN: 9780470655764

Online ISBN: 9781119963783

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Keywords:

  • fetal surgery;
  • open fetal surgery (hysterotomy);
  • indications, for fetal surgical interventions;
  • risks to pregnancy, preterm labor, membrane premature rupture;
  • open fetal surgery techniques;
  • initial uterine entry, Bruner–Tulipan trocar;
  • hysterotomy, fetal surgical approach;
  • fetoscopic surgery, UCSF and endoscopic approaches (Lap-FETENDO);
  • congenital diaphragmatic hernia, and fetoscopic surgery;
  • less invasive FETENDO, FIGS, in fetal intervention

Summary

The first open maternal-fetal operation was performed nearly 30 years ago. The indications for intervention have remained largely constant from the first decade of fetal surgery to the start of the fourth decade and the basic tenets of fetal surgery also have remained consistent. The three basic tenets are: (1) the pregnant woman should undergo minimal risk to her health; (2) the fetal disease should be severe and progressive; and (3) fetal intervention should have a high likelihood for reversing fetal disease. While the diseases treated have remained the same, the approach to fetal interventions has changed dramatically. Initial fetal surgical procedures depended on maternal laparotomy and hysterotomy. This approach evolved into maternal laparotomy with uterine endoscopy and most recently into percutaneous approaches. It appears that the less invasive approaches are associated with a less complicated postoperative recovery for the mother, but morbidity is not eliminated.