Fetal surgery: What to know after Kourtney Kardashian talked 'saving' baby's life

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Pregnancy complications are top-of-mind for many after Kourtney Kardashian revealed she underwent "urgent fetal surgery" that lead to her husband, Travis Barker, halting his band's tour.

The reality TV star opened up a week after Blink-182 announced that two European shows would be postponed "due to an urgent family matter."

In an Instagram post on Wednesday, Kardashian shared a black-and-white photo of her and Barker holding hands as she laid in a hospital bed with her pregnant belly showing.

"I will be forever grateful to my incredible doctors for saving our baby's life," she captioned the post.

"As someone who has had three really easy pregnancies in the past, I wasn't prepared for the fear of rushing into urgent fetal surgery. I don't think anyone who hasn't been through a similar situation can begin to understand that feeling of fear. I have a whole new understanding and respect for the mamas who have had to fight for their babies while pregnant."

There are only about 20 hospitals in North America that offer fetal surgery, and the procedure is done by highly trained pediatric surgeons, fetal cardiologists and other specialists.

But what does the surgery involve, and what are the risks? Read on for everything you need to know about fetal surgery.

What is fetal surgery?

Fetal surgery is a surgical treatment performed on a baby while it's still in the womb. It can also be called in-utero surgery or prenatal surgery.

According to the Cleveland Clinic, the surgery is done to "treat a life-threatening birth defect" or improve outcomes for children born with conditions like spina bifida.

"Some birth defects can threaten a developing fetus. For example, a large lung malformation may compress the fetus' heart. This can lead to heart failure and death," the clinic explained.

In Canada, one centre that handles procedures like fetal surgery is the Ontario Fetal Centre in partnership with Sinai Health and Toronto SickKids hospital. It has named open fetal surgery to repair spina bifida as one of the common fetal therapies it offers.

The Cleveland Clinic claimed fetal surgeons can do minimally invasive procedures as early as 16 weeks of the baby's development. But "for more complex procedures, the ideal window is between 22 and 26 weeks of development."

What conditions require prenatal surgery?

Birth defects are common. Data from 2016 showed that one in 25 babies in Canada are born with a birth defect, also known as a congenital anomaly. In 2021, it was reported 930 people died from a congenital anomaly, deformation or chromosomal anomaly that year.

While some conditions aren't life-threatening, they can "cause disabilities after birth," according to the Cleveland Clinic. "Surgeons commonly treat these conditions after delivery. But treating them before birth can improve long-term outcomes."

Fetal surgery can treat the following conditions, as listed by the Cleveland Clinic:

• Monochorionic twin complications

• Spina bifida

• Congenital lung malformations

• Congenital diaphragmatic hernia

• Congenital high airway obstruction syndrome

• Mediastinal or pericardial teratoma

• Sacrococcygeal teratoma

• Amniotic band syndrome

• Lower urinary tract obstruction

• Large neck masses that cause airway compression

In Canada, the first in-utero spina bifida operation was completed in 2017 at the Ontario Fetal Centre.

What does fetal surgery look like?

The Cleveland Clinic explained in-utero surgery looks differently depending on the condition being treated.

For minor procedures, surgeons might use ultrasound or fetoscopy, where a small instrument is inserted into the uterus in order to see the fetus. That allows surgeons to visualize the baby and "guide surgical instruments through small holes," according to the Cleveland Clinic.

Some conditions, however, may require open surgery which can be "more complex."

"Surgeons have to take care to keep the amniotic environment intact while operating," the Cleveland Clinic noted. "They use special staplers to prevent leaking and continuous infusions to replace lost amniotic fluid."

Are there any risks to the surgery?

A 2019 study on maternal complications in fetal surgery that looked at cases of more than 9,400 patients revealed there was a lack of data on complications.

In open fetal surgeries, maternal complications occurred in 6.2 per cent of fetoscopic and 20.9 per cent of open fetal surgeries. Serious maternal complications occurred in 1.7 per cent and 4.5 per cent of respective procedures.

Mayo Clinic explained some risks of prenatal surgery include:

• A rupture of the uterus after surgery

• Fetal death

• Operative complications

• Early labor

• The potential failure to treat the birth defect

The Cleveland Clinic added blood loss and the need for a blood transfusion as potential risks to the mother, as well as uterine thinning which can affect future pregnancies.

The agency also noted "stress and emotions are high" when families deal with congenital conditions and pregnancy complications.

"This can make the decision process especially difficult for you and your family. You want the best outcome for everyone involved. Your health care team wants that, too."

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