Fetal Therapy & Surgery
The Full Spectrum of Fetal Interventions
From ultrasound-guided minimally invasive procedures to open fetal surgery, for the most complex congenital conditions.
Conditions We Manage
- Congenital airway obstruction (EXIT procedure planning)
- Congenital diaphragmatic hernia (CDH)
- Congenital heart disease & cardiac arrhythmias
- Hydrothorax / chylothorax and pleural effusions
- Fetal lung lesions: CPAM, hybrid lesions, bronchopulmonary sequestration
- Myelomeningocele / spina bifida
- Non-immune hydrops fetalis
- Sacrococcygeal teratoma and neck masses
- Cleft lip & palate
- Intestinal, duodenal and esophageal atresia
- Gastroschisis & omphalocele
- Lower urinary tract obstruction (LUTO) / hydronephrosis
- Twin-to-twin transfusion syndrome (TTTS)
- Selective IUGR in twins
- Acardiac twin (TRAP sequence)
- Discordant anomalies in multiple pregnancies
- Fetal immune disease: Rh isoimmunization, platelet alloimmunization, congenital heart block
- Chorioangioma and pulmonary sequestration
- Amniotic band syndrome
- Placenta accreta spectrum
- High-risk obstetrics: preeclampsia, preterm labour, recurrent loss
Procedures
Twin Pregnancy Interventions
| Procedure | Clinical detail |
|---|---|
| Fetoscopic laser photocoagulation — TTTS | Gold-standard treatment for TTTS (stages I–IV). Selective coagulation of placental anastomoses under fetoscopic guidance. |
| Laser — acardiac twin (TRAP) | Cord coagulation or interstitial laser to stop circulation to the acardiac twin and protect the pump twin. |
| Laser — selective IUGR | Selective interruption of anastomoses in monochorionic twins with abnormal Doppler. |
| Umbilical cord ligation / coagulation | In severe discordant anomalies or acardiac twin, to protect the co-twin. |
Diaphragmatic Hernia & Spina Bifida
| Procedure | Clinical detail |
|---|---|
| FETO — fetal endoscopic tracheal occlusion | Fetoscopic tracheal balloon to stimulate lung growth in severe CDH (O/E LHR <25–35%). Balloon removal at around 34 weeks. |
| Open fetal surgery — myelomeningocele | Hysterotomy-based prenatal closure (MOMS trial approach). Reduces hindbrain herniation and shunt rates and improves motor function. |
| Fetoscopic spina bifida repair | Minimally invasive 3-port approach: lower maternal morbidity, preserved uterus and possible trial of labour. |
Other Interventions
| Procedure | Clinical detail |
|---|---|
| Vesico-amniotic shunt | Ultrasound-guided double-pigtail shunt to drain the obstructed bladder and preserve renal function. |
| Fetal cystoscopy | Laser ablation of posterior urethral valves. |
| Thoraco-amniotic shunt | Drainage of persistent pleural effusions causing lung compression or hydrops. |
| Intrauterine fetal transfusion | For fetal anemia from Rh isoimmunization, anti-Kell or parvovirus B19. |
| Sacrococcygeal teratoma | Laser or radiofrequency ablation of feeding vessels. |
| Chorioangioma / pulmonary sequestration | Interstitial laser, sclerotherapy or feeding-artery ablation. |
| Amniotic band release | Fetoscopic release with laser or scissors. |
| Diagnostic fetoscopy | Direct inspection when ultrasound or MRI cannot fully characterize an anomaly. |