A few fetal diseases may benefit from surgical treatment before birth, but hysterotomy and subsequent delivery by cesarean section pose a risk to the otherwise unaffected mother. To assess maternal risk of mortality, morbidity, and reproductive potential after fetal surgery, we reviewed our experience with 17 highly selected women who underwent fetal surgery. Fifteen of these procedures were performed for one of two congenital anomalies: severe bilateral hydronephrosis and congenital diaphragmatic hernia. There were no deaths or serious maternal injuries. In the 14 women who continued pregnancy after hysterotomy, uterine irritability and preterm labor were frequent complications, requiring early confinement in most cases. There has been no detectable effect on future fertility, as indicated by eight subsequent normal pregnancies. We conclude that hysterotomy for fetal surgery can be accomplished without unduly endangering the mother's life or her future reproductive potential. However, morbidity related to premature labor remains a serious problem, and our ability to control uterine contractions after hysterotomy remains the limiting factor in human fetal surgery.
KIE: The authors describe their experience with 17 highly selected women who underwent hysterotomy for fetal surgery for complex anomalies and then cesarean delivery through the Fetal Treatment Program at the University of California, San Francisco. Maternal risk of mortality, morbidity, and reproductive potential after fetal surgery were assessed. There were no deaths or serious maternal injuries, although the 14 women who continued their pregnancies experienced uterine irritability and preterm labor followed by premature delivery. Seven of the 17 women had eight subsequent normal pregnancies. The authors conclude from their experience that hysterotomy for fetal surgery can be performed without endangering a woman's life or her future fertility. Uterine irritability and premature labor remain serious problems. The authors believe that now is the time to rigorously examine the efficacy, safety, and cost-effectiveness of fetal therapies before they become accepted treatment.