Fetal Surgery for Spina Bifida (Myelomeningocele)

What happens before the procedure?

• You will undergo detailed imaging: high-resolution ultrasound and fetal MRI.
• Amniocentesis is performed to collect amniotic fluid for genetic testing. This is done under ultrasound guidance using a fine needle.
• Lab work includes blood, urine, and vaginal cultures.
• Multidisciplinary consultations with your fetal surgeon, neurosurgeon, neonatologist, and others.
• A tour of the hospital and Spina Bifida Program may also be scheduled.

Will my insurance cover the procedure?

Once approved as a candidate, our team will seek prior authorization from your insurance provider. If denied, a physician may initiate a peer-to-peer review. Coverage decisions are case-specific, and our team works diligently to advocate for necessary care.

When will surgery be scheduled?

If you're eligible, surgery is scheduled between 24 and 26 weeks and 6 days of pregnancy.

What happens on the day of surgery?

• You will receive intravenous fluids and medications (indomethacin for uterine relaxation, Pepcid, Bicitra).
• You’ll meet with the surgical, anesthesia, and neurosurgery teams and sign surgery-related consents.
• Fetal monitoring

What should I expect during the surgery?

The procedure is performed under general anesthesia. You will be asleep during the surgery. Once you are under general anesthesia, a urinary catheter (Foley) will be inserted, and intravenous antibiotics will be administered to help prevent infection. An ultrasound will be performed to check several factors, including the baby’s head position and optimal locations for uterine entry. If the baby’s head is not facing downward, the team may perform an external cephalic version, a gentle maneuver on your abdomen, to turn the baby into a head-down position. Once this is complete and optimal positioning is confirmed, the fetoscopic spinal repair will begin.

How long does the surgery last?

You may be admitted the evening before or the morning of surgery. Admission time depends on final labs and evaluation completion.

We typically schedule surgery to begin at 8:00 AM. Initial steps include anesthesia administration and ultrasound assessment. If needed, the baby may be turned into a head-down position. The actual fetal repair generally begins between 10:30 and 11:00 AM and is expected to be completed by approximately 3:00 PM.

How will my pain be managed in the hospital and after discharge?

While still in the operating room, a member of the anesthesia team will mostly administer a spinal/epidural block before you receive general anesthesia. In addition, you will be offered an abdominal nerve block, which involves the injection of local anesthetic into the abdominal wall muscles using ultrasound guidance. This helps manage pain for the first 24 hours after surgery.

During your hospital stay, pain control will include a combination of medications such as acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) if appropriate, and short-term use of opioids if necessary. Upon discharge, you will receive a personalized pain management plan that primarily includes acetaminophen, with a 2–3 day supply of opioid medication (such as oxycodone) if needed.

How long should I expect to stay in the hospital after surgery?

Patients are generally expected to stay for a minimum of three days following surgery (with surgery day counted as day zero). In some cases, a longer stay may be required to support recovery and ensure your safety.

How often will I be seen after surgery?

• You will have weekly ultrasounds to monitor your baby and uterus.
• Starting at 32 weeks, you will also have weekly non-stress tests (NSTs) to assess fetal well-being.
• At approximately 6 weeks post-surgery, we will conduct another fetal care conference with the above-mentioned teams, including an ultrasound and another MRI. Approximately 30% of fetuses may have reversal of hindbrain herniation after surgery, and the MRI will help identify this.

When will I likely deliver?

The average delivery timing is around 34–35 weeks. However, some patients deliver earlier, and others carry longer if stable. Your provider will monitor you closely and make recommendations based on your and your baby’s health.

What happens after birth?

Your baby will be cared for in the NICU and evaluated by neurosurgery and other specialists. Additional support, such as physical therapy, urology, and developmental care, may begin shortly after birth.

The average NICU stay for babies with spina bifida is about two to four weeks, but this can vary from a few days to several months depending on the specifics of the baby’s medical condition and the gestational age at delivery. The earlier the gestational age at delivery, the longer the stay.

Will my baby need other future surgeries or procedures?

Yes, your baby may need additional surgeries or procedures in the future. These can include surgeries to manage hydrocephalus, surgery to manage tethered cord in which the spinal cord is stuck or pulled tight instead of moving freely, orthopedic procedures to address mobility issues, and interventions for bowel and bladder dysfunction.