. 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 3.

Fetal interventions requiring maternal laparotomy

PROCEDURE	REPORTED PROCEDURAL RISKS	REQUIRED RESOURCES
Open fetoscopic MMC closure ^{119, 129, 130} (i.e. via laparotomy & fetoscopy)	Maternal: Pulmonary edema up to 9%	Maternal: Dedicated intervention setting, L&D unit, OB anesthesiology for neuraxial or general anesthesia and post-operative pain management as required, Blood bank, Adult ICU
	Fetal: PPROM < 37 wks up to 25–38%	Fetal: Fetal MFM surgeon, Pediatric neurosurgery, pediatric surgery, pediatric anesthesiology
	Neonatal: Premature delivery (< 35 weeks 45–52%); perinatal death 3–6%; dehiscence at repair site 4.3–13%	Neonatal: NICU with subspecialty care, Pediatric Neurosurgery
Open fetal MMC closure ^{71, 72, 73, 76} (i.e. via laparotomy & hysterotomy) Open fetal surgery ^{76, 119, 123, 126,}	Maternal: Pulmonary edema 2–6% (up to 27.8% for open fetal surgeries)¹⁴⁴ Intra-operative blood transfusion 1–6% (fetal myelomeningocele repair), 9–13% for other open fetal surgery; ICU admission up to 24.6%,; intubation for > 48 hours up to 2.3%	Maternal: Dedicated intervention setting, L&D unit, OB anesthesiology for neuraxial or general anesthesia and postoperative pain management as required, Blood bank, Adult ICU
	Fetal: Bradycardia requiring resuscitation 5–10%; PPROM < 37 wks: 32–46%; fetal death up to 4.3%¹⁴⁴	Fetal: Fetal MFM surgeon, pediatric neurosurgery, pediatric surgery, pediatric anesthesiology, fetal echocardiography, pediatric subspecialties
	Neonatal: Premature delivery (< 35 weeks 45–52%); perinatal death 3–6%; dehiscence at repair site in current or future pregnancies 4.3–13%	Neonatal: NICU with subspecialty care, e.g., Pediatric Neurosurgery or other condition specific specialties.
Ex-utero intrapartum treatment (EXIT) ^{76, 127, 128}	Maternal: intra-operative atony and hemorrhage	Maternal: Dedicated intervention setting, L&D unit, OB anesthesiology for neuraxial or general anesthesia as required, Blood bank, Adult ICU
	Fetal: Perinatal death 3–14% usually attributable to primary pathology.	Fetal: Multidisciplinary intervention team
	Neonatal: Premature delivery (average GA 31–36 wks).	Neonatal: NICU with subspecialty care

Legend: PTB = preterm birth, ICU = intensive care unit, GA = gestational age, L&D = Labor & Delivery.