What is fetal surgery?

If the baby you're carrying is prenatally diagnosed with a birth defect, treatment before birth may be an option to improve their long-term outcome. Fetal surgery is a highly sophisticated surgical procedure used to treat certain disabling and life-threatening birth defects during fetal development instead of after birth. It is also called prenatal surgery or in utero surgery.

Fetal surgery is performed by fetal surgeons. These are surgeons board certified in both general and pediatric surgery. They have extra training in counseling families facing complex fetal conditions, and experience performing surgery on babies who are still in the womb.

Our team in the Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment at Children’s Hospital of Philadelphia (CHOP) has performed more than 2,250 fetal surgeries, the most of any center in the world. We have been providing this care to patients since 1995.

When is fetal surgery performed?

As technology, fetal imaging and prenatal testing have improved in the past few decades, so has our knowledge of fetal development. Of the approximately 4 million babies born in the United States each year, about 120,000 (3%) have a complex birth defect. Fetal surgery allows us to help babies sooner. Most fetal interventions take place between 23 weeks and 25 weeks and 6 days of pregnancy.

Expanded diagnostic tools have allowed us to identify more precisely when conditions worsen during fetal development. This knowledge has helped us develop new ways to help babies sooner while in utero, including surgery before birth. Today, fetal therapy is recognized as one of the most promising fields in pediatric medicine, and prenatal surgery is becoming an option for a growing number of babies with birth defects.

Where should I go for fetal surgery?

Operating on a tiny baby still in the womb is an extremely complex and delicate procedure. It requires the most expert, comprehensive care for both mother and unborn baby. Few medical teams have the skill and resources to perform such complex procedures, which can present significant risks for both mother and baby.

If you choose CHOP for fetal surgery, you'll be cared for by a team of pioneers who have the greatest combined experience in the world. Every member of our team collaborates to provide the most expert and carefully coordinated care.   

Be sure to ask these questions before you allow a clinical program to perform fetal surgery.

Our commitment to patient safety leads to the best outcomes for both you and your baby. We continue to work to improve maternal safety, refine surgical and imaging techniques, and offer new solutions to conditions developing in utero. Researchers at the Center are actively pursuing stem cell and gene therapies as new options to treat specific birth defects and congenital conditions before birth.

Fetal surgery procedures performed at CHOP

If the baby you're carrying needs fetal surgery, our team is here for you. We perform the full range of fetal surgical procedures. This includes open fetal surgery and minimally invasive procedures.

Few teams have the level of skill and resources we do to carry out such complex procedures. We continue advancing techniques so more babies and families can benefit from the hope they offer. 

Fetal interventions performed at CHOP include:

• Open fetal surgery for life-threatening or devastating fetal conditions
  • Open fetal surgery for myelomeningocele, the most severe form of spina bifida
  • Open fetal surgery for sacrococcygeal teratoma (SCT) resection
  • Open fetal surgery to remove CCAM
• Minimally invasive fetoscopic surgery, including:
  • Bladder and chest shunt placement
  • Fetoscopic endoluminal tracheal occlusion (FETO) for severe CDH
  • Fetoscopic laser ablation (LASER)
  • Bipolar cord coagulation (BCC)
  • Radiofrequency ablation (RFA)
• Ex utero intrapartum treatment (EXIT)
• Fetal cardiac intervention
• In utero stem cell transplantation
• Intrauterine blood transfusions

Fetal Surgeries for Congenital Anomalies

This chart showcases the number and types of fetal surgery procedures performed at CHOP's Center for Fetal Diagnosis and Treatment between 1995 and January 2023.

Prenatal surgery is not indicated in all cases. Many other patients with fetal anomalies are treated surgically after birth by CHOP's multidisciplinary team of experts.

What conditions can be treated with fetal surgery?

As the field of fetal medicine continues to advance, more and more babies will be treated before they are born. Birth defects we have successfully treated in utero with fetal therapies at Children’s Hospital include:

• Amniotic band syndrome
• Bronchopulmonary sequestration of the lung
• Congenital cystic adenomatoid malformation of the lung (CCAM)
• Congenital diaphragmatic hernia (CDH)
• Congenital high airway obstruction syndrome (CHAOS)
• Intrauterine transfusion (IUT)
• Lower urinary tract obstruction (LUTO)
• Mediastinal teratoma
• Neck mass
• Pulmonary agenesis
• Sacrococcygeal teratoma
• Spina bifida (myelomeningocele)
• Twin reversed arterial perfusion sequence (TRAP sequence)
• Twin-twin transfusion syndrome (TTTS)

One day soon, we hope to offer more fetal therapies to more expectant mothers and ultimately, help the next generation of babies enjoy healthier lives.

Learn more about what to expect when undergoing fetal surgery at Children's Hospital of Philadelphia.