Since fetal surgery made its debut in 1981, the field has advanced at an exceptional rate. Treatment options that were unimaginable only a few years ago are regularly saving the lives of unborn babies.
The St. Louis Fetal Care Institute is one of only a handful of centers in the country to offer these live-saving interventions, procedures and surgeries. If there is a way to help an unborn baby, we will find it.
We offer a number of advanced procedures, performed by knowledgeable surgeons and maternal fetal medicine specialists, with the guidance of neonatologists, pediatric specialists, and anesthesiologists.
Below are a few of the advanced interventions we offer:
EXIT (Ex Utero Intrapartum Treatment Procedure) Deliveries
The Ex Utero Intrapartum Treatment Procedure (EXIT procedure) is a special delivery performed when it is anticipated that a baby, or babies in the case of twins, will have an immediate, critical problem once separated from the mother at delivery.
The purpose of an EXIT is to provide the necessary intervention to the baby before the umbilical cord is cut, avoiding the crisis and allowing for a more stable transition from placental circulation to newborn circulation.
The St. Louis Fetal Care Institute performs EXIT procedures at SSM Cardinal Glennon Children’s Medical Center and St. Mary’s Health Center.
Fetoscopic Amniotic Band Release
In the case of amniotic band syndrome, the surgeon uses a tiny laser fiber, inserted through a fetoscope, to break constricting bands of amnion. Sometimes, a small instrument is required to cut the band.
Fetoscopic Laser Photocoagulation of Placental Vessels
In the case of twin to twin transfusion syndrome (TTTS), the surgeon uses a tiny laser fiber, inserted through a fetoscope, to eliminate shared placental blood vessels of twins so that each fetus can develop individually and healthily.
Hydrogel Tracheal Occlusion
In the case of congenital diaphragmatic hernia (CDH), , the surgeon inserted a gel-like substance in the trachea, causing a temporary blockage that helped the lungs to grow and develop with the goal of decreasing the severity of pulmonary hypoplasia. The gel dissolved over time, eliminating the need for a second fetal operation such as with balloon tracheal occlusion.
The purpose of this research trial is to determine how long the gel caused tracheal occlusion during pregnancy. This procedure is currently not being performed because study results are being evaluated and analyzed.
Open Fetal Repair for Myelomeningocele
In the case of a fetal myelomeningocele (spina bifida) repair, the uterus is opened through a small incision, allowing the neurosurgeon to repair the myelomeningocele in utero.
Prenatal Surgery for Bladder Outlet Obstruction
In the case of bladder outlet obstruction, the surgeon uses a fetoscope and laser fiber to eliminate the valves obstructing the urethra. The goal is to prevent further damage to the fetal bladder, kidneys and allow for normal lung development.
In the case of twin-reversed arterial perfusion sequence, one twin has died but there may be a body part which survives only because the surviving twin is providing blood flow to the body part. Rarely, the surviving twin cannot handle the blood flow requirements and develops heart failure.
The solution is to insert a small needle into the umbilical cord going to the body part. Radiofrequency energy waves are used to block the blood flow to the body part, allowing the healthy baby to develop normally.
Open Fetal Resection for Sacrococcygeal Teratoma
In the case of a sacrococcygeal teratoma, the surgeon performs open fetal surgery to remove a tumor from the fetus, which allows the fetus to develop normally.
Tissue Laser Ablation for Tumors
When a tumor, such as a sacrococcygeal teratoma or bronchopulmonary sequestration, grows so large that either it becomes taxing on the heart or compresses the lungs. A laser fiber can be directed through a tiny needle at the feeding blood vessels.
The laser energy blocks the blood vessels, slowing down the growth of the tumor and allowing the baby to develop more normally.
We also use the most up-to-date and advanced imaging tools to diagnose and track fetal conditions so that we can provide families with as much information as possible. Our goal is allow parents to make informed decisions about the care of their unborn child.