A few
fetal diseases may benefit from surgical treatment before birth, but
hysterotomy and subsequent delivery by
cesarean section pose a risk to the otherwise unaffected mother. To assess maternal risk of mortality, morbidity, and reproductive potential after fetal surgery, we reviewed our experience with 17 highly selected women who underwent fetal surgery. Fifteen of these procedures were performed for one of two congenital anomalies: severe bilateral
hydronephrosis and
congenital diaphragmatic hernia. There were no deaths or serious maternal
injuries. In the 14 women who continued pregnancy after
hysterotomy, uterine irritability and
preterm labor were frequent complications, requiring early confinement in most cases. There has been no detectable effect on future fertility, as indicated by eight subsequent normal pregnancies. We conclude that
hysterotomy for fetal surgery can be accomplished without unduly endangering the mother's life or her future reproductive potential. However, morbidity related to
premature labor remains a serious problem, and our ability to control uterine contractions after
hysterotomy remains the limiting factor in human fetal surgery.