World-class fetal surgery at Medical City Dallas’ advanced Fetal Care Center

The maternal-fetal medicine specialists at Medical City Dallas offer advanced fetal care for babies with the full range of congenital disorders. Our Fetal Care Center is home to world-renowned fetal surgeons with expertise in developing nationally recognized, pioneering surgical techniques. From minimally invasive procedures to open fetal surgery, our skilled maternal-fetal medicine doctors can intervene in even the most serious situations.

At Medical City Dallas, moms and babies are cherished and protected. Our Level IV Maternal Designation from the Texas Department of State Health Services indicates that we provide the highest level of maternity care available. Additionally, our Level IV neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU) provide the highest levels of care to the most medically fragile infants and pediatric patients.

Fetal surgery and fetal intervention

Technological advancements have allowed us to know more about your baby’s development in the womb and have greatly improved our ability to provide complex, high-end care for a growing number of congenital anomalies. The Fetal Care Center at Medical City Dallas is one of only a handful of centers in the world capable of performing the full range of fetal surgeries and interventions. We provide leading-edge treatment for the most vulnerable patients with congenital birth defects.

Moms who receive a diagnosis that their unborn child has a complex birth defect can get advanced treatment through fetal intervention or fetal surgery at the Fetal Care Center at Medical City Dallas. Our patients come from all over the United States because their parents trust in the competence of our surgeons, the compassion of our dedicated care teams and the capabilities of our world-class facilities.

With every fetal surgery or intervention that we perform, our goal is to improve outcomes or save a baby’s life. From minimally invasive, ultrasound-guided and laser procedures to complex, open fetal surgery, your baby is in good hands with our maternal-fetal medicine (MFM) specialists and fetal surgeons.

Fetal Care Center specialists will work with you and your referring physician to develop a personalized treatment plan for your unborn baby, including total transfer of obstetrical care if needed, as well as navigation through our Maternal-Fetal Institute.

FETO for congenital diaphragmatic hernia (CDH)

Babies born with a congenital diaphragmatic hernia (CDH) have a congenital anomaly that prevents their lungs form developing normally. In order to maximize lung development and improve your baby’s long-term development, a FETO procedure can be performed in the womb.

Fetoscopic endoluminal tracheal occlusion (FETO) is a specialized type of fetoscopic surgery used to treat babies with severe CDH. During this procedure, a balloon the size of a small grain of rice is inserted into your baby’s trachea, which helps your baby’s lungs to grow and continue to develop beyond what they would without intervention. The balloon is removed prior to delivery.

Medical City Dallas is one of the only hospitals nationwide approved to perform FETO for CDH.

Following birth, babies with CDH may have severely compromised or fragile lungs. Medical City Dallas provides extracorporeal membrane oxygenation (ECMO) for these infants. ECMO is a temporary heart-lung bypass technique that oxygenates the blood and allows the lungs to rest and grow. Treatment may also include diaphragmatic hernia repair.

Fetoscopic surgery

Fetal surgeons at Medical City Dallas use fetoscopic surgery to treat unborn babies diagnosed with congenital diaphragmatic hernia (CDH), spina bifida, twin-to-twin transfusion syndrome (TTTS), bladder outlet obstruction (BOO) and other severe and potentially life-threatening conditions. Fetoscopic surgical procedures our specialists offer include:

  • Bipolar cautery for monoamniotic twin reversed arterial perfusion sequence (TRAP)
  • Devascularization of chorioangioma
  • Fetal thoracoscopy for cystic congenital pulmonary airway malformation (CPAM)
  • Fetoscopic endoluminal balloon tracheal occlusion (FETO) for congenital diaphragmatic hernia (CDH)
  • Laser ablation of posterior urethral valves in BOO
  • Laser bronchotomy for unilateral bronchial atresia
  • Laser laryngotomy for congenital high airway obstruction syndrome (CHAOS)
  • Release of amniotic band syndrome (ABS)
  • Release of cord entanglement in monoamniotic twins
  • Placement of vesicostomy for BOO
  • Selective fetoscopic laser photocoagulation for TTTS

Ultrasound-guided fetal interventions

Ultrasound guidance offers surgeons the ability to perform minimally invasive fetal interventions. This advanced care provides treatment for a variety of congenital anomalies. Ultrasound-guided fetal interventions offered at Medical City Dallas include:

  • Amnioport to maintain amniotic fluid volume in fetuses with low amniotic fluid due to lower urinary tract obstruction or fetal renal abnormalities
  • Aortic balloon valvuloplasty for aortic stenosis/evolving hypoplastic left heart syndrome (HLHS)
  • Interstitial laser devascularization
    • Bronchopulmonary sequestration
    • Chorioangioma
    • Epignathus
    • Hybrid congenital pulmonary airway malformation (CPAM)
    • Sacrococcygeal teratoma
  • Intrauterine blood transfusion
    • rH isoimmunization
  • Radiofrequency ablation for monochorionic twins with life-threatening anomaly in one twin
  • Radiofrequency ablation for twin reversed arterial perfusion sequence (TRAP)
  • Thoracentesis for fetal hydrothorax (FHT)
  • Thoraco-amniotic shunting for FHT and CPAM
  • Vesicoamniotic shunting for bladder outlet obstruction (BOO)
  • Vesicocentesis for BOO

Open fetal surgery

During open fetal surgery, skilled surgeons open mom’s uterus through an incision in the abdomen to provide surgical treatment for congenital anomalies, including spina bifida. The surgery is performed while your baby remains in utero, with the goal of keeping your baby in the womb and maintaining your pregnancy for as long as possible. Open fetal surgeries performed at Medical City Dallas include:

  • Pacemaker placement for complete heart block
  • Repair fetal myelomeningocele
  • Resection of congenital pulmonary airway malformation (CPAM)
  • Resection of pericardial teratoma
  • Resection of sacrococcygeal teratoma (SCT)

Ex-utero intrapartum treatment (EXIT procedures)

EXIT procedures are performed as part of the delivery process. Your baby will continue to receive oxygen and nutrients from mom’s placenta as the necessary surgery is performed. EXIT procedures performed by fetal surgeons at Medical City Dallas include:

  • Exit-to-airway
    • Cervical teratoma
    • Epignathus
    • Lymphangioma
    • Micrognathia
    • Transthoracic retrograde intubation EXIT (TRI-EXIT)
  • EXIT-to-cardiopulmonary bypass
    • Hypoplastic left heart with intact atrial septum
  • EXIT-to-extracorporeal membrane oxygenation (EXIT-to-ECMO)
    • Congenital diaphragmatic hernia (CDH)
  • EXIT-to-pacemaker
    • Complete heart block
  • EXIT-to-resection
    • Bronchogenic cyst
    • Congenital pulmonary airway malformation (CPAM)
    • Sacrococcygeal teratoma
  • EXIT-to-separation
    • Conjoined twins (parasitic twin)

ECMO/mechanical support

Medical City Dallas is equipped to treat the most medically fragile infants. Our advanced treatments include extracorporeal membrane oxygenation (ECMO), a heart-lung support system often used for babies who need a higher level of care. The goal of ECMO is to provide the oxygen that a baby’s body needs and can’t yet make on its own. ECMO may also be used after surgery to aid the healing process.

A large team of experienced caregivers is required to perform ECMO therapy. To ensure the best possible outcomes, our dedicated specialists combine their skills and expertise with compassion and a true desire to care for each child like family. Medical City Children’s Hospital holds a Distinguished Center of Excellence certification from the Extracorporeal Life Support Organization (ELSO), the world’s largest registry of ECMO centers