Anaesthesia for fetal surgeries

The concept of the fetus as a patient has evolved from prenatal diagnosis and serial observation of fetuses with anatomical abnormalities.. Surgical intervention is considered when a fetus presents with a congenital lesion that can compromise or disturb vital function or cause severe postnatal morbidity. Hydronephrosis, saccrococcygeal teratoma, hydrocephalus, meningomyelocoele and diaphragmatic hernia are some of the defects that can be diagnosed by imaging and are amenable to intervention. The combination of underdeveloped organ function and usually life-threatening congenital malformation places the fetus at a considerable risk. Fetal surgery also leads to enhanced surgical and anaesthetic risk in the mother including haemorrhage, infection, airway difficulties and amniotic fluid embolism. There are 3 basic types of surgical interventions: 1.Ex utero intrapartum treatment(EXIT), 2.Midgestation open procedures, 3.Minimally invasive midgestation procedures. These procedures require many manipulations and monitoring in both the mother and the unborn fetus.