Open Fetal Surgery for SCT & Vascular Tumors

Overview

In open fetal surgery for sacrococcygeal teratoma (SCT) or vascular tumors, the uterus is opened surgically, revealing the fetus. The tumor is removed without taking the fetus from the uterus. Afterward, the uterus and abdomen are closed, and the fetus continues to develop. When a fetus has an SCT or large vascular tumor, the heart is required to work at a much higher level to pump blood to the tumor, as well as the rest of the body. Sometimes the result is fetal hydrops, a type of heart failure that can lead to premature delivery or fetal death. The condition also can jeopardize the mother’s health.

If the fetus develops early signs of high cardiac output and is not ready to be born, usually at less than 30 weeks gestational age, open fetal surgical excision of the tumor may be recommended. Best results are achieved if the condition is treated before that fetus shows frank signs of hydrops. Successful removal of the tumor prevents hydrops, so the chances of a longer pregnancy are increased.

About the procedure

Open fetal surgery is performed on an inpatient basis. The mother is given general anesthesia for complete pain relief, and the fetus may receive anesthesia as well. An incision, similar to that for a cesarean section, is made in the mother’s abdomen. The uterus is lifted slightly and surgically opened to expose the fetal tumor. The tumor is removed, and the removal site is closed. The surgeon will close the uterus and place it back inside the mother, and then the abdominal incision is repaired. Generally, mothers recover in the hospital for several days after surgery, and the remainder of the pregnancy will be closely monitored.

Every surgical procedure carries risks. The risks for open fetal surgery include harm to the fetus and premature labor. Your doctors at Texas Children’s Fetal Center will conduct a thorough evaluation, which may include including ultrasound, fetal echocardiogram and amniocentesis, before deciding if open fetal surgery is an appropriate option. The maternal “mirror syndrome” should be ruled out before fetal surgery.