There are three main types:[2] open fetal surgery, which involves completely opening the uterus to operate on the fetus; minimally invasive fetoscopic surgery, which uses small incisions and is guided by fetoscopy and sonography; and percutaneous fetal therapy, which involves placing a catheter under continuous ultrasound guidance.
[citation needed] This risk is higher than for a typical Cesarean section, for several reasons: Tocolytics are generally given to prevent labor;[3] however, these should not be given if the risk is higher for the fetus inside the womb than if delivered, such as may be the case in intrauterine infection, unexplained vaginal bleeding and fetal distress.
[3] Open fetal surgery is similar in many respects to a normal cesarean section performed under general anesthesia, except that the fetus remains dependent on the placenta and is returned to the uterus.
A hysterotomy is performed on the pregnant woman, and once the uterus is open and the fetus is exposed, the fetal surgery begins.
[citation needed] The main priority is maternal safety, avoiding preterm labor and achieving the aims of the surgery.
After birth, exposure of the spinal cord to the outside environment (myelomeningocele or spina bifida) is associated with several morbidities including weakness or sensory defecits in the lower extremities, bladder dysfunction, fluid buildup in the brain and Type 2 Chiari malformations (herniation of the cerebellar vermis and medulla from the brain into the spinal canal.
[10] On April 26, 1981, the first successful human open fetal surgery in the world was performed at University of California, San Francisco, under the direction of Dr. Michael Harrison.
[11][12] The fetus in question had a congenital hydronephrosis, a blockage in the urinary tract that caused the kidney to dangerously extend.
[13][quantify] Dr. Oluyinka Olutoye, alongside Darrell Cass, from the Texas Children's Fetal Centre, removed a 23-week-old fetus from her mother's womb in order to perform surgery upon a spinal tumor she had.