What Is Fetal Surgery? These Procedures Are Incredibly Rare

Kourtney Kardashian recently announced on Instagram that she had to undergo “urgent fetal surgery.” Her husband, Blink-182 drummer Travis Barker, postponed tour dates and rushed home to be by her side. While Kardashian and Barker didn’t specify why their unborn baby boy needed medical attention, Kourt shared that she and baby were doing just fine post-op. Naturally, the post brought up a lot of questions: What is fetal surgery, exactly, and how is it done? How common are procedures like this, and how many pregnant people require them?

What is fetal surgery?

For starters, fetal surgery is actually an umbrella term that refers to any procedure performed during a pregnancy, either on the fetus or the placenta, says Dr. Elizabeth Langen, M.D., director of research for the Maternal Fetal Medicine Division at C.S. Mott Children’s Hospital, and associate professor of obstetrics and gynecology at the University of Michigan.

The goal? “To improve the outcome of a pregnancy because there is something pathologic or worrisome going on with the pregnancy, with the baby, or with the placenta,” says Dr. Nicholas Behrendt, M.D., maternal fetal medicine specialist at Children’s Hospital Colorado and the University of Colorado School of Medicine. There are different types of fetal surgery, and the kind a person receives obviously depends on the condition affecting their baby.

Why would your baby need fetal surgery?

This question is kind of like asking why any person might need surgery — it depends. Langen and Behrendt say some of the most common conditions that require surgical treatment during pregnancy include:

• Fetal anemia: A condition that causes the baby’s hemoglobin and red blood cell count to drop, which can be treated with a blood transfusion. It’s most commonly caused by a blood type mismatch between the mother and father or an in-utero infection.
• Twin-to-twin transfusion: Twins who share a placenta can sometimes split the nutrition unevenly, leaving one undernourished. During a minimally invasive procedure, surgeons can separate the placenta using a laser.
• Spina bifida: Surgeons can repair myelomeningocele, a severe form of spina bifida, in the womb, which often leads to better outcomes for babies than undergoing reparative surgery after birth.
• Abnormal fluid buildup: If a growing fetus develops fluid in a part of their body where they shouldn’t, it can cause distress and developmental challenges. The most common form of fluid buildup in fetuses happens in the chest cavity, and can make it hard for the lungs to grow properly.

Before you get concerned, both surgeons say these conditions — and the need for fetal surgery in general — is exceedingly rare. If you’re pregnant or trying to conceive, the chances you’ll need an intervention like this are slim to none.

“Less than 1% of pregnancies ever have a discussion about this or ever have a fetal surgery,” Behrendt says. “Because of the high stakes, we do them only in situations where the benefit outweighs the risk. Almost all fetal surgeries are done in situations where there is a significant issue going on, one that if we do not take on the risk of fetal surgery, than we would expect poor outcomes.”

How is fetal surgery done?

If you’re wondering how in the world doctors can perform surgery on a fetus still growing in the womb, you’re not alone — it sounds almost like science fiction. But it happens, and it’s 100% real. How exactly the procedure goes, naturally, depends on what the surgeons are treating.

“For some folks, the fetal procedure is done with an ultrasound and a needle that goes inside of the uterus to do the procedure, and that is sort of one level of intervention,” says Langen. “Other procedures are done where what we call a hysteroscope, a very small camera, is placed into the uterus to allow us to intervene on structures inside the uterus. That can be the placenta or part of the baby. And other times it can be actually what we call open fetal surgery, where the mother is placed under general anesthesia and there’s actually an opening in her belly so that we can open up the uterus very carefully, operate on the fetus, and then close the uterus again to allow the pregnancy to continue.”

Blood transfusions to treat fetal anemia, for example, go something like this: “We give a blood transfusion to the fetus through the umbilical cord by guiding a needle into the umbilical cord through the mom’s abdomen using ultrasound to be able to give blood. We can sample blood and give blood,” Behrendt says.

Treating spina bifida can be done minimally invasively, but sometimes requires open fetal surgery, Behrendt says. In those cases, maternal-fetal specialists open the mother’s abdomen, then the uterus, and pediatric neurosurgeons repair the spinal defect like they would on a baby who has already been born.

While it’s highly unlikely that you or anyone you know will ever need fetal surgery, it’s a reminder that pregnancy really is both a miracle and a gauntlet for some. “Fetal surgery is really stressful for the mom, the baby, and all the family who are supporting them,” Langen says. “It’s important that we just think about how vulnerable pregnant people are and the fact that these types of procedures have to exist. It’s another reason why we need to be thoughtful and respectful of pregnant people in our society.”

Experts:

Dr. Elizabeth Langen, M.D., director of research for the Maternal Fetal Medicine Division at C.S. Mott Children’s Hospital, and associate professor of obstetrics and gynecology at the University of Michigan

Dr. Nicholas Behrendt, M.D., maternal fetal medicine specialist at Children’s Hospital Colorado and the University of Colorado School of Medicine