Intrauterine Fetal Procedures

Fetal Blood Sampling

Fetal blood sampling, or cordocentesis, may be performed in rare situations where fetal blood is required to evaluate the baby. Cordocentesis involves guiding a needle through the abdomen to the umbilical cord. This allows our maternal fetal medicine specialists to sample the baby’s blood, give a blood transfusion or administer special medication before birth.

Percutaneous Fetal Procedures

Percutaneous fetal procedures use an ultrasound to guide a needle or needle-like instrument into the womb. For example, in cases of bladder outlet obstruction, a shunt (tiny flexible tube) may be placed in the fetal bladder. To place the shunt in the bladder, a tiny skin incision is made on the mother’s abdomen. A special catheter is then inserted into the fetal bladder to allow drainage of fluid into the amniotic cavity. The procedure is often performed using local anesthesia or an epidural, combined with IV sedation. After recovery from the procedure, the mother may be discharged and followed closely as an outpatient.

EXIT Procedure

Spectrum Health and Helen DeVos Children’s Hospital offer families a full team of maternal fetal medicine specialists as well as pediatric and fetal surgeons working together. We offer immediate access to the region’s most sophisticated neonatal intensive care unit (NICU) and a full pediatric surgery team.

The EXIT (Ex Utero Intrapartum Treatment) Procedure is a highly-modified Cesarean delivery which requires an experienced multidisciplinary team. The goal is to partially deliver the baby while maintaining placental support to perform surgery before the baby is completely delivered.

Instead of stopping blood flow and separating the placenta from the uterus in a traditional Cesarean, an EXIT procedure allows continued oxygenation between mother and baby. This maintains the circulation of blood, nutrients and oxygen to the baby while the surgical team performs all necessary treatments. An EXIT procedure may be used for conditions such as:

  • Large fetal neck mass
  • Congenital diaphragmatic hernia
  • Congenital high airway obstruction
  • Lung mass

An EXIT procedure is performed in an operating room with special equipment and monitors to ensure the safety of you and your baby throughout the procedure.

General anesthesia is used to relax the uterus and maintain blood flow to the placenta during the operation. The incision is similar to a standard Cesarean that allows for possible future vaginal deliveries. The baby receives anesthesia through the placenta, as well as additional anesthesia delivered by a shot.

When the procedure is complete, the umbilical cord is cut and the baby is delivered. The mother is given medication to cause the uterus to contract, the placenta is removed, and the uterus and abdomen are closed.

The mother will be admitted to the birth center and the baby is admitted to the NICU. Recovery for the mother is similar to a regular Cesarean delivery.