Abstract
 
 

ABSTRACT

The routine antenatal screening for congenital disorders in the fetus has made a sea change the way we look at the fetus. With the availability of high-resolution ultrasound machines, we have technology to diagnose fetal structural defects, with high degree of certainty. Some of these babies can go through the entire pregnancy and can be operated upon after delivery without additional morbidity and mortality. Fetus with diaphragmatic hernia needs fetal surgery for better survival, while the fetus with myelomeningocele can be operated upon postnatally, but neurological outcome for the baby is better if operated upon in utero. Fetal surgery is performed in the second trimester of pregnancy either by open route or by endoscopy. Endoscopy route is still evolving and generally used to coagulate the communicating vessels in cases of twin-twin transfusion syndrome. Open fetal surgery involves hysterotomy, control of hemorrhage from edges of hysterotomy wound, aspiration of amniotic fluid, delivery of effected fetal part to the hysterotomy wound, corrective surgery, closure of uterine incision, and instillation of aspirated amniotic fluid back to uterus. Postoperatively, the patient is given tocolytics and antibiotics to avoid preterm labor and infection respectively. At appropriate date, the baby is delivered by cesarean section. Despite several benefits, fetal surgery cannot be considered safe for the mother and the fetus. It is associated with considerable maternal morbidity like hemorrhage, preterm delivery, chorioamnionitis, and so forth. It also needs coordinated team effort with a dedicated team of obstetrician, anesthetist, pediatrician, and other specialized surgeons of concerned deformity in the fetus. Currently, fetal surgery is a new frontier of fetomaternal medicine and may be labeled as evolving science, and the facility should be limited to highly specialized tertiary care centers to gain more experience. However, the future of fetal surgery as an effective tool to correct the congenital defects for the fetus is promising.

Keywords: Fetal surgery, Minimally invasive fetal surgery, Open fetal surgery.

How to cite this article: Kumar S, More M, Sharma S. Fetal Surgery: A Basic Overview and a Glimpse into Its Future. MGM J Med Sci 2017;4(1):35-38.

Source of support: MGMIHS

Conflict of interest: None

 
 
 


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