Fetal Surgery: Review

Maged Naser, Mohamed MN, Lamia H. Shehata


About 1% of all pregnancies have structural abnormalities. During the last thirty years, different experimental studies in large animals, related with the development of diagnostic imaging and fetoscopy, have prompted incredible advancement in the   pathophysiology of different birth defects. Such knowledge applied to intrauterine correction of anomalies has changed the natural history of a several already deadly illnesses, prompting an extensive number of survivors. Fetal intervention, like open fetal surgery, might be demonstrated in meningomyelocele or in inherent cystic adenomatoid malformation, and in sacrococcygeal teratoma, which lead to secondary fetal hydrops. Furthermore, minimally invasive procedures using fetoscopy may have application in an inborn diaphragmatic hernia, in feto-fetal transfusion, in twin pregnancies with acardiac fetus, in the posterior urethral valve, and in hypoplasia of the cardiovascular chambers, with great outcomes. Despite minimally invasive procedures the fact that open fetal surgery and minimally invasive procedures are as yet experimental and still should be completely approved, the correct ultrasound diagnosis and the patient's referral to tertiary centers   giving multidisciplinary fetal services add to the survival of fetuses with inherent diseases of generally fatal evolution.


Congenital abnormalities/surgery; Fetus/abnormalities; Fetus/surgery; Fetoscopy

Full Text:



- Baird, Patricia A., et al. "Genetic disorders in children and young adults: a population study." American journal of human genetics 42.5 (1988): 677.

- Albanese, Craig T., and Michael R. Harrison. "Surgical treatment for fetal disease: The state of the art." Annals of the New York Academy of Sciences 847.1 (1998): 74-85.

- Hirose, Shinjiro, Claudia Meuli-Simmen, and Martin Meuli. "Fetal surgery for myelomeningocele: panacea or peril?." World journal of surgery 27.1 (2003): 87-94.

- Adzick, N. S. "Fetal cystic adenomatoid malformation of the lung: diagnosis, perinatal management, and outcome." Seminars in thoracic and cardiovascular surgery. Vol. 6. No. 4. 1994.

- Graf, Joy L., et al. "Successful fetal sacrococcygeal teratoma resection in a hydropic fetus." Journal of pediatric surgery 35.10 (2000): 1489-1491.

- Doné, Elisa, et al. "Prenatal diagnosis, prediction of outcome and in utero therapy of isolated congenital diaphragmatic hernia." Prenatal Diagnosis: Published in Affiliation with the International Society for Prenatal Diagnosis 28.7 (2008): 581-591.

- Lewi, Liesbeth, Jacques Jani, and Jan Deprest. "Invasive antenatal interventions in complicated multiple pregnancies." Obstetrics and Gynecology Clinics 32.1 (2005): 105-126.

- Liechty, Kenneth W., and Timothy M. Crombleholme. "Management of fetal airway obstruction." Seminars in perinatology. Vol. 23. No. 6. WB Saunders, 1999.

- Michejda, Maria. "Intrauterine treatment of spina bifida: primate model." Zeitschrift für Kinderchirurgie 39.04 (1984): 259-261.

- Meuli, Martin, et al. "Creation of myelomeningocele in utero: a model of functional damage from spinal cord exposure in fetal sheep." Journal of pediatric surgery 30.7 (1995): 1028-1033.

- de Sá, Renato Augusto Moreira, et al. "Is intrauterine surgery justified? Report from the working group on ultrasound in obstetrics of the World Association of Perinatal Medicine (WAPM)." Journal of perinatal medicine 44.7 (2016): 737-743.

- Sydorak, Roman M., and Michael R. Harrison. "Congenital diaphragmatic hernia: advances in prenatal therapy." World journal of surgery 27.1 (2003): 68-76.

- Farrell, Jody A., et al. "Maternal fertility is not affected by fetal surgery." Fetal diagnosis and therapy 14.3 (1999): 190-192.

- Osaka, Kunihiko, et al. "Myelomeningocele before birth." Journal of neurosurgery 49.5 (1978): 711-724.

- Stark, Gordon D., and Geoffrey CW Baker. "The neurological involvement of the lower limbs in myelomeningocele." Developmental Medicine & Child Neurology 9.6 (1967): 732-744.

- STARK, GORDON D., and MARGARET DRUMMOND. "The spinal cord lesion in myelomeningocele." Developmental Medicine & Child Neurology 13 (1971): 1-14.

- Dillon, C. M., et al. "Longevity of patients born with myelomeningocele." European Journal of Pediatric Surgery 10.S 1 (2000): 33-34.

- Bruner, Joseph P., et al. "Fetal surgery for myelomeningocele and the incidence of shunt-dependent hydrocephalus." Jama 282.19 (1999): 1819-1825.

- Walsh, Danielle S., et al. "The rationale for in utero repair of myelomeningocele." Fetal diagnosis and therapy 16.5 (2001): 312-322.

- Heffez, Dan S., et al. "The paralysis associated with myelomeningocele: clinical and experimental data implicating a preventable spinal cord injury." Neurosurgery 26.6 (1990): 987-992.

- Heffez, Dan S., et al. "Intrauterine repair of experimental surgically created dysraphism." Neurosurgery 32.6 (1993): 1005-1010.

- Drewek, Michael J., et al. "Quantitative analysis of the toxicity of human amniotic fluid to cultured rat spinal cord." Pediatric neurosurgery 27.4 (1997): 190-193.

- Urich, H. "Malformations of the nervous system, perinatal damage and related conditions in early life." Greenfield's neuropathology (1973): 361-469.

- Lary, Joseph M., and Larry D. Edmonds. "Prevalence of spina bifida at birth—United States, 1983–1990: A comparison of two surveillance systems." Teratology 56.1‐2 (1997): 19-30.

- Sbragia, Lourenço. "Tratamento das malformações fetais intraútero." Revista Brasileira de Ginecologia e Obstetrícia 32.1 (2010): 47-54.

- Campbell, J., et al. "Ultrasound screening for spina bifida: cranial and cerebellar signs in a high-risk population." Obstetrics and Gynecology 70.2 (1987): 247-250.

- Centers for Disease Control (CDC. "Economic burden of spina bifida--United States, 1980-1990." MMWR. Morbidity and mortality weekly report 38.15 (1989): 264-267.

- Worley, Gordon, James M. Schuster, and W. Jerry Oakes. "Survival at 5 years of a cohort of newborn infants with myelomeningocele." Developmental Medicine & Child Neurology 38.9 (1996): 816-822.

- Hutchins, Grover M., et al. "Acquired spinal cord injury in human fetuses with myelomeningocele." Pediatric Pathology & Laboratory Medicine 16.5 (1996): 701-712.

- Kohl, Thomas, et al. "Percutaneous fetoscopic patch closure of human spina bifida aperta: advances in fetal surgical techniques may obviate the need for early postnatal neurosurgical intervention." Surgical endoscopy 23.4 (2009): 890-895.

- Doyle, Nora M., and Kevin P. Lally. "The CDH Study Group and advances in the clinical care of the patient with congenital diaphragmatic hernia." Seminars in perinatology. Vol. 28. No. 3. WB Saunders, 2004.

- Golombek, Sergio G. "The history of congenital diaphragmatic hernia from 1850s to the present." Journal of perinatology 22.3 (2002): 242-246.

- Stege, Gerben, Alan Fenton, and Bruce Jaffray. "Nihilism in the 1990s: the true mortality of congenital diaphragmatic hernia." Pediatrics 112.3 (2003): 532-535.

- Morini, Francesco, et al. "Treatment strategies for congenital diaphragmatic hernia: change sometimes comes bearing gifts." Frontiers in pediatrics 5 (2017): 195.

- Madderom, Marlous J., et al. "Congenital diaphragmatic hernia with (out) ECMO: impaired development at 8 years." Archives of Disease in Childhood-Fetal and Neonatal Edition 98.4 (2013): F316-F322.

- Sydorak, Roman M., and Michael R. Harrison. "Congenital diaphragmatic hernia: advances in prenatal therapy." World journal of surgery 27.1 (2003): 68-76.

- Wilson, Jay M., John W. DiFiore, and Craig A. Peters. "Experimental fetal tracheal ligation prevents the pulmonary hypoplasia associated with fetal nephrectomy: possible application for congenital diaphragmatic hernia." Journal of pediatric surgery 28.11 (1993): 1433-1440.

- Kanai, Masaki, et al. "Fetal tracheal occlusion in the rat model of nitrofen-induced congenital diaphragmatic hernia: tracheal occlusion reverses the arterial structural abnormality." Journal of pediatric surgery 36.6 (2001): 839-845.

- Kitano, Yoshihiro, et al. "BAPS Prize—1999: Lung growth induced by prenatal tracheal occlusion and its modifying factors: A study in the rat model of congenital diaphragmatic hernia." Journal of pediatric surgery 36.2 (2001): 251-259.

- Sylvester, Karl G., et al. "Tracheal occlusion reverses the high impedance to flow in the fetal pulmonary circulation and normalizes its physiological response to oxygen at full term." Journal of pediatric surgery 33.7 (1998): 1071-1075.

- Lipshutz, Gerald S., et al. "Prospective analysis of lung-to-head ratio predicts survival for patients with prenatally diagnosed congenital diaphragmatic hernia." Journal of pediatric surgery 32.11 (1997): 1634-1636.

- Deprest, Jan, et al. "Fetoscopic surgery: encouraged by clinical experience and boosted by instrument innovation." Seminars in fetal and neonatal medicine. Vol. 11. No. 6. WB Saunders, 2006.

- Liechty, Kenneth W., et al. "Intrapartum airway management for giant fetal neck masses: the EXIT (ex utero intrapartum treatment) procedure." American journal of obstetrics and gynecology 177.4 (1997): 870-874.

- Sbragia, Lourenço, et al. "Congenital diaphragmatic hernia without herniation of the liver: does the lung‐to‐head ratio predict survival?." Journal of ultrasound in medicine 19.12 (2000): 845-848.

- Jani, Jacques C., et al. "Fetal lung-to-head ratio in the prediction of survival in severe left-sided diaphragmatic hernia treated by fetal endoscopic tracheal occlusion (FETO)." American journal of obstetrics and gynecology 195.6 (2006): 1646-1650.

- Sebire, Neil J., et al. "The hidden mortality of monochorionic twin pregnancies." BJOG: An International Journal of Obstetrics & Gynaecology 104.10 (1997): 1203-1207.

- Farmer, Diana L., and Shinjiro Hirose. "Fetal intervention for complications of monochorionic twinning." World journal of surgery 27.1 (2003): 103-107.

- Carroll, Stephen GM, et al. "Prediction of chorionicity in twin pregnancies at 10–14 weeks of gestation." BJOG: an international journal of obstetrics and gynecology 109.2 (2002): 182-186.

- Diehl, W., et al. "Placental vascular anastomoses visualized during fetoscopic laser surgery in severe mid-trimester twin–twin transfusion syndrome." Placenta 22.10 (2001): 876-881.

- Bermúdez, Carlos, et al. "Placental types and twin-twin transfusion syndrome." American journal of obstetrics and gynecology 187.2 (2002): 489-494.

- Quintero, Rubén A., et al. "Staging of twin-twin transfusion syndrome." Journal of Perinatology 19.8 (1999): 550-555.

- Elliott, JOHN P., MICHAEL A. Urig, and WILLIAM H. Clewell. "Aggressive therapeutic amniocentesis for treatment of twin-twin transfusion syndrome." Obstetrics and Gynecology 77.4 (1991): 537-540.

- Mari, Giancarlo, et al. "Perinatal morbidity and mortality rates in severe twin-twin transfusion syndrome: results of the International Amnioreduction Registry." American journal of obstetrics and gynecology 185.3 (2001): 708-715.

- Senat, Marie-Victoire, et al. "Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome." New England Journal of Medicine 351.2 (2004): 136-144.

- Napolitani, F. Donald, and Irving Schreiber. "The acardiac monster: a review of the world literature and presentation of 2 cases." American Journal of Obstetrics and Gynecology 80.3 (1960): 582-589.

- Sherer, David M., et al. "Prenatal sonographic diagnosis, Doppler velocimetric umbilical cord studies, and subsequent management of an acardiac twin pregnancy." Obstetrics and gynecology 74.3 Pt 2 (1989): 472-475.

- Tsao, KuoJen, et al. "Selective termination of acardiac/acephalic twin by radiofrequency ablation." Twin Research and Human Genetics 4.3 (2001): 211.

- Hecher, K., et al. "Twin reversed arterial perfusion: fetoscopic laser coagulation of placental anastomoses or the umbilical cord." Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology 28.5 (2006): 688-691.

- Bondagji, Nabeel S. "Antenatal diagnosis, prevalence and outcome of congenital anomalies of the kidney and urinary tract in Saudi Arabia." Urology annals 6.1 (2014): 36.

- Brumfield, C. G., et al. "Fetal obstructive uropathies. Importance of chromosomal abnormalities and associated anomalies to perinatal outcome." The Journal of reproductive medicine 36.9 (1991): 662-666.

- Nakayama, Don K., Michael R. Harrison, and Alfred A. de Lorimier. "Prognosis of posterior urethral valves presenting at birth." Journal of pediatric surgery 21.1 (1986): 43-45.

- Mahony, B. S., P. W. Callen, and R. A. Filly. "Fetal urethral obstruction: US evaluation." Radiology 157.1 (1985): 221-224.

- Housley, H. Tamiko, and Michael R. Harrison. "Fetal urinary tract abnormalities: Natural history, pathophysiology, and treatment." Urologic Clinics of North America 25.1 (1998): 63-73.

- Mahony, B. S., et al. "Fetal renal dysplasia: sonographic evaluation." Radiology 152.1 (1984): 143-146.

- Johnson, Mark Paul, et al. "In utero surgical treatment of fetal obstructive uropathy: a new comprehensive approach to identify appropriate candidates for vesicoamniotic shunt therapy." American journal of obstetrics and gynecology 170.5 (1994): 1770-1779.

- Qureshi, Faisal, et al. "In utero fetal urine analysis and renal histology correlate with the outcome in fetal obstructive uropathies." Fetal diagnosis and therapy 11.5 (1996): 306-312.

- Donnenfeld, Alan E., et al. "Prenatal diagnosis from fetal urine in bladder outlet obstruction: success rates for traditional cytogenetic evaluation and interphase fluorescence in situ hybridization." Genetics in Medicine 4.6 (2002): 444-447.

- Wataganara, Tuangsit, and Sujin Kanokpongsakdi. "Changing landscapes of in utero minimally invasive surgical interventions." Siriraj Medical Journal 60.6 (2008): 368-370.

- Pluto Collaborative Study Group. "PLUTO trial protocol: percutaneous shunting for lower urinary tract obstruction randomised controlled trial." BJOG: An International Journal of Obstetrics & Gynecology 114.7 (2007): 904-e4.

- Rychik, Jack, et al. "The hypoplastic left heart syndrome with intact atrial septum: atrial morphology, pulmonary vascular histopathology and outcome." Journal of the American College of Cardiology 34.2 (1999): 554-560.

- Matsui, Hikoro, and Helena Gardiner. "Fetal intervention for cardiac disease: the cutting edge of perinatal care." Seminars in Fetal and Neonatal Medicine. Vol. 12. No. 6. WB Saunders, 2007.

- Wilkins‐Haug, L. E., et al. "Factors affecting technical success of fetal aortic valve dilation." Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology 28.1 (2006): 47-52.

- Marshall, Audrey C., et al. "Results of in utero atrial septoplasty in fetuses with hypoplastic left heart syndrome." Prenatal Diagnosis: Published in Affiliation With the International Society for Prenatal Diagnosis 28.11 (2008): 1023-1028.

- Turner, Christopher GB, et al. "Cardiac anomalies in the fetus." Clinics in perinatology 36.2 (2009): 439-449.

- Bodian, M., L. L. R. White, and C. O. Carter. "JH LOUW, Ch. M., FRC~., FACS-LIST OF PUBLICAno S." Clin. Proc. Vol. 7. 1948.

DOI: http://dx.doi.org/10.52155/ijpsat.v25.2.2863


  • There are currently no refbacks.

Copyright (c) 2021 Maged Naser, Mohamed MN, Lamia H. Shehata

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.