Maternal Fetal Surgery: Procedure, Recovery and Results

Maternal fetal surgery is a highly specialised form of care that treats certain serious fetal conditions during pregnancy or around the time of birth. It is considered only when a multidisciplinary team believes the possible benefit to the baby outweighs the important risks to both the pregnant person and the pregnancy.

Overview: what is maternal fetal surgery?

Maternal fetal surgery, also called fetal surgery or fetal intervention, is treatment performed on a fetus during pregnancy or in a carefully planned delivery setting. It may be used when a structural problem, abnormal blood flow, tumour or other condition could cause serious harm before birth and may be improved by treatment before or at delivery.

Fetal procedures range from needle-based treatments and fetoscopic procedures using small instruments to open surgery involving an incision in the uterus. A related approach, called ex utero intrapartum treatment (EXIT), allows a specialist team to begin treating the baby while placental circulation is temporarily maintained during delivery.

These treatments are not routine and are offered only at experienced fetal care centres. The central aim is to balance the expected benefit for the baby with the safety of the pregnant person, while preserving the pregnancy whenever possible.

How maternal fetal surgery works and who may be a candidate

Candidacy begins with confirmation of the diagnosis. High-resolution ultrasound, fetal echocardiography, magnetic resonance imaging (MRI), genetic testing and amniocentesis may be recommended, depending on the suspected condition. The team also assesses gestational age, placental location, fetal position, maternal health and whether there are additional abnormalities that could affect outcomes.

Conditions sometimes considered for fetal intervention include twin-to-twin transfusion syndrome, some cases of spina bifida (myelomeningocele), severe lower urinary tract obstruction, fetal lung lesions, selected congenital diaphragmatic hernias, fetal anaemia, airway obstruction and certain tumours. The appropriate treatment depends on the individual diagnosis; many fetal conditions are monitored during pregnancy and treated after birth instead.

A multidisciplinary team typically includes maternal-fetal medicine specialists, fetal surgeons, obstetric anaesthetists, neonatologists, paediatric surgeons, radiologists, genetic specialists, nurses and psychosocial support professionals. Families should receive clear counselling about alternatives, including expectant monitoring, postnatal treatment and, where appropriate, pregnancy options under local laws and medical guidance.

Step by step: what happens during the procedure

Before treatment, the pregnant person usually has repeat imaging, blood tests and anaesthesia assessment. The team discusses consent, possible changes to the plan and the possibility of early delivery. Medications may be given to support comfort, reduce uterine contractions or prepare the baby for a possible preterm birth when clinically appropriate.

For a minimally invasive procedure, ultrasound guides a needle, catheter or small camera into the uterus. For example, fetoscopic laser treatment can seal abnormal blood-vessel connections in the placenta in selected twin pregnancies. In open fetal surgery, the abdomen and uterus are opened under general anaesthesia, the fetus is positioned carefully for the repair, and the uterus is closed after the procedure. The fetus usually receives pain relief and anaesthesia through the maternal circulation and/or direct medication as determined by the anaesthesia team.

Continuous ultrasound and, when feasible, fetal heart-rate monitoring help guide the procedure. Afterward, the pregnant person is monitored in hospital for contractions, bleeding, fluid leakage, infection and fetal wellbeing. The care plan is individual because procedure type and pregnancy stage strongly influence observation needs.

For conditions involving complex pregnancy and neonatal care, treatment planning may overlap with high-risk pregnancy care and coordinated newborn support. The goal is not simply to complete a procedure, but to plan safely for the remainder of pregnancy, delivery and neonatal care.

Benefits, risks and recovery timeline

The potential benefit of maternal fetal surgery is that it may prevent deterioration before birth, improve organ function, reduce the severity of a condition or make later treatment safer. For some diagnoses, early intervention may improve survival or functional outcomes. However, it cannot always reverse damage that occurred before treatment, and it does not guarantee a normal outcome.

Risks to the pregnant person can include anaesthesia complications, bleeding, infection, blood clots, injury to nearby organs and complications from a uterine incision. Pregnancy-related risks include contractions, premature rupture of membranes, placental problems, fetal distress, miscarriage, stillbirth and preterm delivery. Open uterine surgery may affect future pregnancies and often means that later deliveries need to be by planned caesarean birth.

Recovery varies. After a needle-based or fetoscopic procedure, some people return home within one to several days if monitoring is reassuring. Open fetal surgery generally requires a longer hospital stay, followed by frequent outpatient visits and ultrasound checks. Physical activity restrictions, medication and travel advice are individual; the care team should provide written instructions and a direct contact pathway for new symptoms.

Follow-up typically continues until delivery, often at a centre equipped for high-risk obstetric and neonatal care. Delivery timing and method are planned around the fetal diagnosis, response to treatment and any maternal or pregnancy complications.

How difficult is fetal surgery?

Fetal surgery is among the most technically demanding areas of medicine because clinicians must care for two patients while maintaining pregnancy. It requires precise imaging, specialised anaesthesia, advanced obstetric surgery and immediate access to neonatal and paediatric expertise.

The difficulty differs substantially by procedure. An ultrasound-guided transfusion or shunt may be less invasive than fetoscopic surgery, while open fetal surgery is a major operation with a longer recovery and more significant pregnancy-related risks. Even minimally invasive procedures require careful planning because the uterus, placenta and fetus can respond unpredictably.

For families, the decision can also be emotionally demanding. A specialist fetal care team can explain the likely benefits, uncertainties, alternatives and practical issues such as monitoring, delivery planning and support at home.

What are the long-term effects of fetal surgery?

Long-term effects of fetal surgery depend primarily on the condition being treated, how severe it was before treatment, the type and timing of the procedure, and whether preterm birth occurred. Some children need ongoing paediatric follow-up, rehabilitation, further surgery or support for developmental, neurological, respiratory, urological or mobility needs.

For the pregnant person, long-term considerations may include scar healing and planning for future pregnancies. Following open fetal surgery, a uterine scar can increase the risk of uterine rupture in a later pregnancy, so future obstetric care should be discussed with a maternal-fetal medicine specialist. A planned caesarean delivery may be advised in the current and future pregnancies.

Long-term follow-up is an important part of care, not a sign that treatment has failed. It allows clinicians to monitor the child’s growth and development and to address needs early. Families can ask what follow-up is expected for their specific fetal diagnosis before deciding on treatment.

How long does fetal surgery take?

There is no single duration for fetal surgery. Ultrasound-guided procedures may take less than an hour, although preparation, anaesthesia, imaging and recovery monitoring make the overall hospital visit longer. Fetoscopic procedures often take several hours from operating-room entry to recovery.

Open fetal surgery generally takes several hours and involves additional time for anaesthesia, surgical preparation, fetal monitoring and postoperative observation. The clinical team can give the most accurate estimate after reviewing the diagnosis, gestational age, placental position and planned technique.

Time in the operating room is only one part of treatment. The period of surveillance afterward, including monitoring for contractions or fluid leakage and regular fetal imaging, is equally important for safety.

What type of fetal surgery did Kardashian have?

Kim Kardashian has publicly described undergoing fetal surgery during pregnancy to treat a placenta-related complication. Public reports have described a procedure intended to address retained placenta or placental tissue and reduce the risk of bleeding; details of an individual’s medical care are private and should not be used to guide another person’s treatment.

Her experience does not represent every type of fetal or maternal-fetal procedure. Many treatments discussed under the broad term “fetal surgery” are performed to address a fetal condition, while others are procedures during pregnancy focused on a maternal or placental complication. A clinician can clarify the specific procedure relevant to an individual diagnosis.

When to seek medical care

Anyone with a known or suspected fetal condition should seek timely evaluation from their obstetrician or a maternal-fetal medicine specialist. Urgent contact with a maternity unit is important for vaginal bleeding, leaking fluid, fever, severe or persistent abdominal pain, regular contractions, fainting, shortness of breath, severe headache, sudden swelling, vision changes or a noticeable reduction in fetal movements after movements have become established.

After a fetal procedure, the care team will give specific warning signs and contact instructions. It is important not to wait for a scheduled appointment if symptoms develop, even if they seem mild. Prompt assessment can help identify contractions, infection or membrane rupture early.

Acibadem International’s multidisciplinary specialists and JCI-accredited hospitals support international patients requiring complex maternal-fetal assessment and coordinated pregnancy care. Decisions about fetal intervention should always be made with qualified specialists who can review the individual pregnancy and available treatment options.

Frequently asked questions

Is maternal fetal surgery safe?

Maternal fetal surgery can be beneficial for carefully selected conditions, but it carries meaningful risks for both the pregnant person and the fetus. Safety depends on the diagnosis, procedure type, gestational age, maternal health and experience of the specialist centre. A detailed assessment and counselling process are essential before treatment is considered.

Can fetal surgery be performed at any stage of pregnancy?

No. Each procedure has a specific time window based on fetal development, the condition being treated and the expected balance of benefit and risk. Some interventions are performed in the second trimester, while others are planned close to delivery or immediately after birth. The fetal care team determines whether timing is appropriate.

Does fetal surgery always require open surgery?

No. Many fetal interventions are performed with ultrasound guidance through a needle or with fetoscopy through small openings. Open fetal surgery is reserved for selected situations where a more extensive repair may offer a meaningful benefit. The least invasive effective option is generally considered first.

Will a baby still need treatment after fetal surgery?

Often, yes. Fetal treatment may stabilise a condition, reduce its severity or improve the chance of a safer birth, but it may not provide a complete cure. Babies may need specialised monitoring, surgery, medication or rehabilitation after delivery depending on the underlying diagnosis.

Can a person have another pregnancy after open fetal surgery?

Many people can have future pregnancies after open fetal surgery, but they require specialist obstetric planning. The uterine incision may increase risks in later pregnancies, including uterine rupture. A maternal-fetal medicine specialist can advise on appropriate spacing, monitoring and delivery planning.

How is fetal surgery different from neonatal surgery?

Fetal surgery is performed before or during birth, while neonatal surgery is performed after the baby is born. Fetal intervention is considered when waiting until after delivery may lead to irreversible harm or a poorer outcome. In many cases, neonatal surgery remains the safer and preferred option.

References

• American College of Obstetricians and Gynecologists
• Society for Maternal-Fetal Medicine
• International Fetal Medicine and Surgery Society
• Children's Hospital of Philadelphia Center for Fetal Diagnosis and Treatment
• National Institute of Child Health and Human Development

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.