A proposed ethics framework for conceptualization of the perioperative-neonatal window in open fetal surgery

Antenatal maternal-fetal surgery and intervention (MFSI) endeavors to reduce the morbidity and mortality of the unborn child but raises unique and challenging issues around fetal patienthood and medical risk to the pregnant person without direct physiological benefit. An aspect of open MFSI that has not been adequately discussed is the emergent delivery of a viable fetus. While rare, this potential occurrence provides an important starting point to analyze novel ethical issues that do not exist in other spaces. Specifically, there are unanswered ethical questions regarding where the perioperative window ends and neonatal resuscitation begins, and how this affects the zone of parental discretion and what obligations clinicians have in these instances. This paper will provide an ethical analysis centered on emergent delivery of a viable fetus during mid-trimester open MFSI, including a practical framework for clinicians to guide their practice and assist in pre-procedural counseling.