. Author manuscript; available in PMC: 2023 Jun 1.

Published in final edited form as: Obstet Gynecol. 2022 May 2;139(6):1027–1042. doi: 10.1097/AOG.0000000000004793

Table 1.

Ultrasound guided needle based fetal interventions

PROCEDURE	REPORTED PROCEDURAL RISKS	REQUIRED RESOURCES
Fetal blood sampling and transfusion^{19, 21, 70, 91, 92} Needle size: 22–20 gauge (outer diameter 0.71–0.91 mm)	Maternal: Urgent delivery	Maternal: L&D unit if viable; OB anesthesiology for IV conscious sedation⁸⁴ or rarely neuraxial anesthesia⁸⁵
	Fetal: Puncture site bleeding 20–30%; transient bradycardia 5–10%; fetal death 0.4%; up to 25% for complicated fetal disease and hydrops.	Fetal: Trained intervention team, Blood bank for preparation of fetal blood products, medications for fetal paralysis/resuscitation.
	Neonatal: Premature delivery (average gestational at birth: 31–35 weeks; condition specific)	Neonatal: NICU if viable with subspecialty access for complex or severe conditions
Fetal cardiac interventions^{25, 81} Needle size 18–16 Gauge (outer diameter 1.27 – 1.65 mm)	Maternal: Post-operative pain up to 32%; post-operative nausea or vomiting up to 26%	Maternal: L&D unit if viable; OB anesthesiology for sedation / neuraxial / general anesthesia as required
	Fetal: Transient hemopericardium 18%–28%; ; Bradycardia up to 32; IUFD by 48 hours 10–30%	Multidisciplinary fetal cardiac intervention team (Blood bank to prepare fetal blood products)^** Medication for fetal paralysis/resuscitation
	Neonatal: Premature delivery (<37 weeks up to 20%; fetal death before discharge up to 61%)	Neonatal: NICU, with pediatric cardiology / cardiac surgery, pediatric anesthesiology and subspecialty access
Radiofrequency, microwave, or interstitial laser ablation^{95–97, 100, 101} Instrumentsize: 18–16 Gauge (outer diameter 1.27–1.65 mm)	Maternal: Myometrial bleeding <1%	Maternal: Dedicated intervention setting, OB Anesthesiology for IV conscious sedation and, rarely, neuraxial anesthesia; L&D unit for post-procedure monitoring
	Fetal: Miscarriage within 2 weeks 3%; thermal injury of co-twin 2%; co-twin demise 10–16%; PPROM within 2 weeks 2–9%	Fetal: Trained intervention team
	Neonatal: Premature delivery (<32 weeks 9–18%; <37 weeks 9–18%)	Neonatal: NICU after viability

Legend: Ø = diameter, OB anesthesiology = Obstetric Anesthesiology, LUTO = lower urinary tract obstruction, L&D = Labor & Delivery, NICU = neonatal intensive care unit, PTB = preterm birth, PPROM = preterm premature rupture of membranes.

^**

Not typically used, but may be required on a case by case basis in the absence of fetal compromise.