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Surgery Before Birth: A Guide to Foetal Surgery for Expectant Parents

ByDr. Furqan Aamer
Updated: 8 Nov 2026, 11:00 am

Foetal surgery is a specialised procedure performed during pregnancy to treat conditions such as spina bifida and twin-twin transfusion syndrome. Depending on the diagnosis, surgery before birth can improve survival, prevent complications, or support the baby’s development.

Pregatips
Foetal surgery treats a birth defect while the baby is still in the womb. It is used for conditions such as spina bifida and twin-twin transfusion syndrome, to prevent complications, support organ development, or improve survival. Surgeons use a needle, a thin camera-guided instrument, or an operation involving the uterus. It is offered only in selected pregnancies where benefits outweigh the risks to mother and baby, and depends on the condition, the stage of pregnancy (usually 16–26 weeks), and the treatment centre’s expertise.
In this article:
To get accurate, doctor-verified information, we reached out to Dr Tanushree Mukherjee, Senior Consultant Pediatrician and Neonatologist at Cloudnine Group of Hospitals, Mumbai, Malad.

Which Conditions Can Be Treated With Foetal Surgery?

Foetal surgery is not a first-line treatment. A team of foetal medicine specialists considers it after detailed scans when a condition threatens the baby's survival, organ development, or long-term health. Conditions treated include:

  • Spina bifida (myelomeningocele): This birth defect occurs when the spine and spinal cord do not develop properly. Surgery before birth may reduce certain complications, including problems related to fluid buildup around the brain.
  • Twin-twin transfusion syndrome (TTTS): In some identical twin pregnancies, the babies share a placenta and have an abnormal connection between their blood vessels. Laser treatment can seal these connections and improve outcomes. Untreated severe TTTS carries a foetal mortality rate of 90–100%.
  • Congenital diaphragmatic hernia (CDH): In severe cases, an opening in the diaphragm allows abdominal organs to move into the chest, affecting lung development.
  • Lung masses and tumours: Such as congenital pulmonary airway malformation (CPAM) and sacrococcygeal teratoma.
  • Foetal anaemia: Severe anaemia can occur when a baby has too few red blood cells. An intrauterine blood transfusion may help restore the baby's red blood cell levels.
  • Urinary tract obstruction: A blockage in the baby's urinary tract can affect kidney development and reduce the amount of amniotic fluid. Selected cases may benefit from a procedure to drain urine into the amniotic sac.
Not every foetal condition requires surgery. Eligibility depends on the diagnosis, severity, gestational age, maternal health, and the potential benefits and risks. The team carefully evaluates whether intervention is likely to improve survival, reduce disability, or prevent further damage.Dr Tanushree Mukherjee, Sr Consultant, Pediatrician and Neonatologist, Cloudnine Group of Hospitals

What Are the Different Types of Foetal Surgery?

Surgeons choose the method by condition.

1. Needle-guided foetal procedures: Doctors use ultrasound to guide a needle or thin tube into the uterus. This approach can be used for intrauterine blood transfusions, fluid drainage, and selected procedures to relieve blockages.

2. Fetoscopic surgery: A thin instrument with a camera about 3 mm wide is passed through a small opening in the uterus. It allows surgeons to perform procedures such as laser treatment for TTTS without making a large incision in the uterus.

3. Open foetal surgery: The surgeon makes an incision in the mother's abdomen and uterus to operate on the baby. It may be used for selected conditions, such as certain cases of spina bifida. It is more invasive and requires careful planning.

4. Fetoscopic tracheal occlusion (FETO): A balloon is placed in the baby's windpipe in severe CDH to promote lung growth.

What Are the Risks of Foetal Surgery?

The possible complications vary according to the procedure and the mother's health.

Risks to the mother: These may include bleeding, infection, complications from anaesthesia, injury to surrounding tissues, and weakening or scarring of the uterus.

Risks to the baby: These may include premature birth, pregnancy loss, bleeding, infection, or failure of the procedure to correct the underlying problem. Some procedures also increase the likelihood of needing a caesarean birth.

After certain open foetal surgeries, the mother may need a caesarean birth in the current pregnancy and future pregnancies because of the uterine incision.

Foetal surgery can offer an important treatment option for certain conditions diagnosed before birth, but the safest approach depends on an individual assessment by an experienced multidisciplinary team.

FAQs on Surgery Before Birth: A Guide to Foetal Surgery for Expectant Parents

  1. Is foetal surgery safe?
    It carries risks for mother and baby, including preterm labour and early rupture of membranes. Teams offer it only when the expected benefit outweighs the risk, and maternal safety is the priority.
  2. At what stage of pregnancy is foetal surgery done?
    Usually between 16 and 26 weeks. TTTS laser surgery is done at 16–26 weeks and spina bifida repair at 19–26 weeks.
  3. Does every birth defect require foetal surgery?
    No. Many conditions can be monitored during pregnancy or treated after birth. Foetal surgery is reserved for selected cases where intervention before birth may improve outcomes.
Medically Reviewed By:
Dr Tanushree Mukherjee, Senior Consultant Pediatrician and Neonatologist at Cloudnine Group of Hospitals, Mumbai, Malad

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