Fetal Surgery: History of Innovation | The Children's Hospital of Philadelphia

Center for Fetal Diagnosis and Treatment

Fetal Surgery: History of Innovation

It took a small group of medical professionals, committed to curing life-threatening birth defects before birth, to unlock the secrets of the fetus. Together, they proved fetal therapy was more than science fiction — that it could be an effective treatment for thousands of babies worldwide.

Today, fetal therapy is recognized as one of the most promising fields in pediatric medicine.

Highly sophisticated surgical teams now repair extremely disabling birth defects like spina bifida and other life-threatening congenital conditions in the womb.   

Pioneers in fetal medicine

Members of our team have been pioneering advances in fetal therapy since the field originated several decades ago. In 1995, we recruited top fetal surgeons, obstetricians and advanced practice nurses to create the Center for Fetal Diagnosis and Treatment (CFDT) at The Children’s Hospital of Philadelphia. Our program quickly became recognized as an international leader in fetal care. 

One of only a few Centers of its kind in the world, the CFDT offers a comprehensive breadth of services — including fetal therapy — to support patients from prenatal evaluation through delivery, postnatal care and long-term follow-up.

Treating birth defects before birth: a growing field

Of the approximately 4 million babies born in the United States each year, about 120,000 (3 percent) have a complex birth defect. 

For years, maternal-fetal specialists have known that some birth defects could be successfully treated after birth. But as technology, fetal imaging and prenatal testing have improved in the past few decades, so too has our knowledge of fetal development.

With these expanded diagnostic tools we can literally see what’s happening in the womb — month by month, week by week, day by day. This has allowed us to identify more precisely when conditions worsen during fetal development, and has spurred our passion to develop new ways to help babies sooner. 

Fetal surgery allows us the opportunity to intervene earlier; to treat certain birth defects during fetal development instead of after birth, and to offer new hope to families.

History of fetal surgery

Before we could offer any fetal therapy, we had to ensure it was safe for the pregnant mother. 

Center leaders were among the founders of modern fetal medicine and worked alongside other leading surgeons and researchers in experimental laboratories to develop the techniques they hoped someday to use clinically.

After extensive study, Center leaders began to offer fetal therapy to carefully selected patients. Prenatal counseling was imperative, especially in the early days, and clinicians were extremely honest about what they could and could not do for the fetus, what outcomes they hoped for, and what risks existed for both fetus and mother.

Since 1995, more than 15,700 expectant families have been referred to our Center. Our staff has the world's greatest collective experience treating babies with birth defects. Each month we diagnose and treat fetal conditions that are so rare, many physicians will only see one or two cases in their careers. Patients have been referred to our Center from all 50 states and more than 50 counties for the comprehensive care and treatment we offer. 

More options in fetal surgery

As the field of fetal medicine continues to advance, more and more babies will be treated before they are born. At our Center, fetal therapies range from open fetal surgery to minimally invasive procedures.

Birth defects we have successfully treated with fetal therapies include:

For additional diagnoses we treat, see fetal diagnoses

Our fetal medicine staff members continue to work to improve maternal safety, refine surgical and imaging techniques, and offer new solutions to conditions developing in utero. Researchers at the Center are actively pursuing stem cell and gene therapies as new options to treat specific birth defects and congenital conditions before birth.

One day soon, we hope to offer more fetal therapies to more expectant mothers and ultimately, help the next generation of babies enjoy healthier lives.

Why choose fetal therapy at Children’s Hospital

Fetal surgery is a huge decision for your family. You need to be confident that the team you’ve chosen to address your baby’s birth defect has the expertise, experience and compassion to perform one of the most complex surgical procedures and guide you through this challenging time in your life.

You want to know the doctors and nurses you are trusting will treat your baby like their own; that they will fight for the best possible outcome for your baby and your family.

At the Center for Fetal Diagnosis and Treatment, we take that responsibility seriously and have crafted our program to meet the needs of your family and other families like yours who are dealing with an uncertain future for an unborn baby.

Highlights of our unique program include:

Coordinated care in one location

From the first phone call to our Center, we coordinate all of your treatment, offering information and support at every part of your journey.

We provide complete care for mothers carrying babies with known birth defects — from fetal diagnosis and, if possible, prenatal management, to delivery and postnatal care.

All of your care will be provided in one comfortable, family-centered location that was designed to produce optimal outcomes for you and your baby.

Our Center team works closely with all pediatric subspecialties at Children's Hospital that may be needed by you or your baby. Experts from neonatology, pulmonology, neurology, cardiology, urology, orthopaedics, radiology, gastroenterology and nutrition and more — are immediately available.

If you have fetal surgery, you will likely be a patient twice in our Garbose Family Special Delivery Unit (SDU), the world’s first birth facility designed for mothers carrying babies with known birth defects. You will stay here before and after fetal surgery, and again when it is time to deliver your baby.

We will work closely with your physician back home to coordinate your care, and we are experienced working with insurance companies and other payers to ensure you and your baby have access to the most appropriate treatment. 

Facilities designed for you

Our Center is unique: It is one of the only maternal/fetal centers located within a pediatric hospital in the United States.

Everything about our Center has been created to provide optimal care to you and your baby. Before delivery, our team uses the most advanced imaging technologies, diagnostic tools and prenatal testing to diagnose and monitor babies in utero.

The SDU is staffed and fully equipped to manage the delicate care you and your unborn baby require before, during and after fetal surgery, as well as the care needed at the time of your baby’s delivery.

The SDU features:

After delivery in the SDU, your baby will be cared for in our Newborn/Infant Intensive Care Unit, which has been recognized as among the best in the nation by U.S.News & World Report, or the Cardiac Intensive Care Unit, part of the Hospital’s world-renowned Cardiac Center.

Expertise and experience 

As one of the most active maternal fetal centers in the nation, the expertise and experience of our Center staff is evident in our numbers:

Most recently, our Center co-led the groundbreaking Management of Myelomeningocele Study (MOMS). The NIH-funded clinical trial proved that fetal repair of myelomeningocele (the most serious form of spina bifida) can produce better outcomes than repair after birth. Study results were published in February 2011 in The New England Journal of Medicine. Fetal surgery for spina bifida is now a standard of care at our Center.

Care at our Center is shaped by our belief that the fetus is a separate patient. Therefore, every member of our multidisciplinary team is an expert in caring for unborn babies, their mothers and families.

Our Center team has extensive experience delivering babies and caring for laboring mothers who’ve had fetal surgery. Learn more about our team.

Our partners in neonatology have worked with us since our program launched. They are incredibly experienced taking care of babies who have had fetal surgery, babies with birth defects, and babies who are critically ill or need immediate postnatal care.

The Newborn/Infant Intensive Care Unit offers comprehensive facilities, high-tech equipment and close monitoring by a highly-trained team of neonatologists, nurses, therapists, specialists and support staff.   

Support services for your family

A cornerstone of our care is the exceptionally thorough counseling families receive before fetal surgery. Counseling includes:

We offer a full range of support services and support staff who can help you and your family overcome challenges in receiving care and coping with your baby's diagnosis and treatment, and connect you with additional resources closer to your home.

Along with doctors, nurses and therapists, our Center has full-time social workers, Child Life specialists, lactation consultants, and a host of other specialty services that you, your baby or your family may need. The Hospital offers several comprehensive long-term follow-up programs to ensure your baby has a lifetime of support.

We’ve also created a tremendous breadth of educational materials for families considering fetal surgery or other treatment at our Center. Please see fetal surgery and the SDU or contact us online for more information. 

We want to address your concerns and will support you in any way we can.  

Contact us

For more information or to schedule an evaluation, please contact the Center for Fetal Diagnosis and Treatment at 1-800-IN-UTERO (1-800-468-8376) or contact us online.

November 2013

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