Anesthesia for Fetal Surgery

Anesthesia on a pregnant mother for procedures on the fetus is a highly specialized area of anesthesiology and requires experience and skill in managing two patients, mother and her unborn baby, and the unique challenges associated with surgical interventions on unborn babies.

The maternal-fetal anesthesiologist requires a comprehensive understanding of pregnancy and fetal physiology to provide effective and safe care for both patients. This branch of fetal medicine involves administering anesthesia and pain management to unborn babies during certain medical procedures. The fetus receives anesthesia in two ways: through medications given to the mother which reach the fetus through her blood circulation, or anesthesia is given directly through ultrasound-guided injections or intramuscular injection to the fetus when the surgeon has access to the fetus during open fetal surgeries.

Maternal-fetal medicine requires the collaboration of a multidisciplinary team of health care professionals including maternal-fetal medicine specialists, surgeons, neonatologists and perioperative staff. Fetal anesthesiologists play a key role in this collaborative effort, allowing that the anesthesia plan aligns with the overall treatment strategy to provide optimal outcomes for the unborn baby and the mother.

Fetal anesthesia is necessary during fetal surgeries or procedures that involve the fetus directly, such as and not limited to, laser ablation of twin-to-twin transfusion syndrome, in utero blood transfusions or interventions to correct congenital anomalies like spina bifida. The primary goal is to keep the mother and fetus comfortable, pain free and immobile during these interventions. Anesthesiologists administer weight-based medications and monitor both mother and baby to reduce stress.

Any medication or sedation given to the mother can potentially affect the fetus since everything passes through the placenta. Thus, only the medications essential for the procedure are used in weight-based doses.

In general, the decision to use fetal anesthesia is made after discussion with the maternal fetal surgery team that carefully evaluates the risks and benefits of the procedure for both the mother and the baby. If the procedure is deemed necessary, the fetal team will take all precautions to minimize risks.

Every pregnant woman’s physiology is unique and specialized care is essential to safeguard the well-being of both the pregnant mother and unborn baby. Collaboration is central in the field of fetal anesthesia. Our affiliated fetal team embraces an interdisciplinary approach, conducting frequent meetings and discussions involving surgeons, anesthesiologists, nurses and other specialists to assess each patient’s individual case. Our fetal anesthesiologists customize the anesthesia plan to meet the patient’s specific requirements and demands of the fetal procedure.

Expectant mothers should be well-informed about the type of sedation or anesthesia they will receive. Clear communication with the team is essential for addressing concerns and questions.

For patients before surgery, the fetal anesthesiologist will discuss your medical history, allergies, current medications, prior anesthesia experiences and current health. They will inquire about your baby’s gestational age, prenatal tests and any known fetal issues. After a thorough review, your fetal anesthesiologist will explain the risks and benefits of the recommended anesthesia for your specific surgery.

Our affiliated maternal-fetal anesthesiologists work closely with the patient and the health care team to develop an anesthesia plan that is tailored to the patient’s specific needs and requirements of the procedure. This patient-centered approach helps improve outcomes for both the mother and baby.

Typically, an anesthesiologist is responsible for the mother and unborn baby as they are considered one unit. However, if a situation arises where the baby needs to be treated as a separate entity, additional anesthesiologists may be involved. In the operating room, there is usually one anesthesiologist in cases where the delivery of the baby is not expected and a multidisciplinary team of pediatric surgeons, neonatologists and specialists are available if needed.

The affiliated team will monitor both the mother and the baby closely after the fetal procedure to help enhance their well-being. Depending on the situation, additional care or follow-up appointments may be necessary. The medical team will provide guidance on postanesthesia care.

Our affiliated maternal-fetal anesthesiologists have undergone rigorous training to deliver anesthesia and pain management that is tailored specifically for pregnant women and their unborn babies. They have a deep understanding of the unique physiological changes that occur during pregnancy, comorbidities of the patient, physiology of neonates and physiology of transition from neonatal circulation to newborn if the baby is born, allowing them to develop personalized anesthesia plans to provide care that is specialized and personalized.