Maternal risks of fetal surgery and implications for future pregnancy

Fetal surgery is performed through the pregnant woman, so maternal safety and bodily autonomy are central. The mother may receive no direct physical benefit from the intervention while accepting risk for a possible fetal benefit. That asymmetry requires unusually careful consent.

Risks in the current pregnancy

Risks vary by procedure and access route. They may include anaesthetic complications, bleeding, infection, injury to maternal organs, thromboembolism, medication reactions, pain, admission, fluid leakage, membrane rupture, placental bleeding or separation, contractions, preterm birth, emergency cesarean delivery, and pregnancy loss.

Fetoscopic ports usually create less uterine disruption than an open hysterotomy, but “minimally invasive” does not mean minor. Membrane complications and preterm birth can materially affect neonatal outcome.

Future-pregnancy implications

An open fetal operation involving hysterotomy can create a uterine scar with implications for later pregnancy and delivery, including the possibility of uterine dehiscence or rupture and a requirement for planned cesarean birth before labour. The implications of fetoscopic access differ, but should still be discussed using procedure- and programme-specific evidence.

Consent should remain balanced

Counselling should separate:

• the chance and magnitude of fetal benefit;
• maternal short- and long-term risk;
• fetal and neonatal procedural risk;
• uncertainty and technical failure;
• alternatives, including no prenatal operation;
• implications for delivery and future pregnancy;
• additional burdens such as travel, separation from family, recovery, and prolonged neonatal care.

The pregnant woman may decline an offered procedure even when the team believes it could benefit the fetus. Her decision should be respected without coercion.

After any fetal procedure, heavy bleeding, severe or worsening pain, fluid leakage, fever, shortness of breath, fainting, regular contractions, or reduced fetal movements requires urgent maternity assessment.