FETAL CARE
The Super Bowl of Surgeries
What can the medical community learn from a rare and risky surgery to resect a fetal pericardial teratoma in utero ?
In January 2022 , providers from across Children ’ s Hospital Colorado gathered in an operating room in the Colorado Fetal Care Center to save not one life , but two . A mother from Omaha , Nebraska had made her way to Colorado after learning that her 27-week-old fetus had a large mass pressing against its heart and needed immediate care . The mass threatened to send the fetus into hydrops , or heart failure , and carried additional risks to the mother ’ s health . The team carefully weighed their options and decided the best course of action was to complete the resection while the fetus remained in utero .
Even before the patient sought initial care at her local hospital , the groundwork for this unique surgery was already laid thanks to the relationships Bettina Cuneo , MD , a fetal cardiac specialist , had formed with providers there . So , when this difficult case arose , the patient ’ s doctors referred her to the team at Children ’ s Colorado , knowing they ’ d be able to provide the best care for this rare defect .
“ Part of the rarity of this case was the combination of the disease and how it affects the baby ,” says James Jaggers , MD , a cardiac surgeon at Children ’ s Colorado who helped plan and complete the resection . “ It probably happens more than we know , but this fetus and this family were lucky enough to be plugged into a situation where they could get to [ Dr . Cuneo ] and then get to us for intervention .”
When the patient arrived in Colorado , doctors faced a difficult choice due to the young gestational age of the fetus : “ Do we deliver early , do the operation and leave the baby out , or do we do the operation with the fetus still attached to the mother and put the baby back in to continue growing ?” Dr . Jaggers recalls .
Based on the fetus ’ s significant prematurity and the tumor ’ s large size , the team decided to pursue an option that ’ s only been documented a handful of times in the literature : in utero resection . That , according to Drs . Cuneo and Jaggers , would give the fetus the best chance of survival . After all , there ’ s no better ICU for a fetus than a mother ’ s uterus , says Kenneth Liechty , MD , a fetal surgeon who played a critical role as a co-surgeon in this case .
Though the resection itself is a relatively common surgery , this unusual element , in which the fetus would be partially removed from the uterus for the operation and then placed back inside ,
4 | CHILDREN ’ S HOSPITAL COLORADO