Children's Hospital Colorado
Colorado Fetal Care Center
Colorado Fetal Care Center

Fetal Interventions and Procedures

Dr. Crombleholme operates with a team of surgeons.

For expectant mothers carrying babies who have been diagnosed with a fetal abnormality, the Colorado Fetal Care Center offers a variety of highly specialized, advanced fetal interventions and procedures.

Over the last decade, our team has worked diligently to improve detection and treatment for fetal conditions. As a result, our capabilities have grown exponentially. Today, the Colorado Fetal Care Center provides virtually every fetal treatment available.

Fetal interventions at the Colorado Fetal Care Center

Our team members are skilled in the latest fetal therapies, treatments and interventions. By treating various fetal anomalies during pregnancy instead of after birth, we allow babies to start healing before they’re even born, giving them a better chance at the best possible outcome.

Our world-renowned physicians offer life-saving fetal interventions that:

  • Correct problems that would be too advanced to treat after the baby is born
  • Minimize long-term disabilities
  • Prevent a life-threatening situation by treating the fetus while it’s still within the mother’s uterus
  • Bypass a complication, such as fetal airway obstruction, that could be fatal at birth

With a focus on each child’s long-term quality of life, we offer some of the most innovative fetal therapies available today, including:

Minimally invasive fetal procedures:

This type of fetal intervention involves minimally invasive techniques that treat and correct life threatening fetal conditions, ideally before they can cause long lasting disability or death.

During these fetal interventions, the fetal surgeon inserts a tiny fiber optic camera (a fetoscope) and other specialized instruments through a small incision in the mother’s abdomen and uterus, and then minimizes or corrects the abnormality.

These fetoscopic and ultrasound-guided interventions let the surgical team clearly visualize, access and treat fetuses while they’re still tucked inside their mothers’ womb.

Open fetal surgery

Some conditions necessitate open fetal surgery while the mother is still pregnant. For open fetal surgeries, a team of fetal surgeons opens the mother’s abdomen and then makes a small opening in her uterus, exposing the area where the fetus requires surgery.

Then, they correct the fetal defect and close the uterus and abdomen so the baby can keep growing and developing.

Fetal interventions we perform

We have state-of-the-art fetal surgery suites and expertise in performing both minimally invasive and open fetal surgical procedures. This makes our team poised to obtain the best possible outcome for babies with severe to life-threatening fetal abnormalities.

The following experts are available for both mom and baby:

  • Fetal surgeons, including maternal fetal medicine specialists and pediatric surgeons
  • Fetal cardiologists
  • Obstetric and fetal anesthesiologists
  • Pediatric subspecialists
  • Dedicated fetal operating room and obstetric nurses

Our team is fully equipped to perform a full range of fetal surgeries, interventions and procedures, including:

  • Twin-to-twin transfusion syndrome (TTTS) laser surgery procedures, including:
    • Selective fetoscopic laser photocoagulation (SFLP) for TTTS
    • Radiofrequency ablation (RFA) or umbilical cord coagulation
  • Ex-Utero Intrapartum Treatment (EXIT procedures)
  • Fetoscopic endoluminal tracheal occlusion (FETO) for severe congenital diaphragmatic hernia (CDH)
  • Fetal shunt placement
  • Open fetal surgery
  • Ultrasound-guided procedures such as intrauterine blood transfusions
  • Amniotic band resection for amniotic band syndrome (ABS)

An Ex Utero Intrapartum Treatment (or EXIT procedure) is an operative intervention requiring general anesthesia for the mother. The anesthesia relaxes the uterus and passes through the placenta to the fetus. This intervention is utilized for operative procedures on the fetus. The baby will be delivered at the end of the EXIT procedure. The placental bypass during the fetal procedure allows for fetal stability during the operative phase for the fetal diagnosis. A neonatal resuscitation team is available for the delivery.

Fetoscopic tracheal occlusion is used to accelerate lung growth in babies with conditions like severe left congenital diaphragmatic hernia (CDH). Because the greatest risk to a baby with CDH is pulmonary hypoplasia or underdevelopment of the lungs, intervention before birth is necessary to accelerate both lung growth and pulmonary vascular development.

Tracheal occlusion with a detachable balloon is performed using a small fetoscope with attached camera. A fetal surgeon will maneuver the balloon into the fetus's mouth and down the trachea. After inserting the tracheal balloon fetoscopically, the lungs will be encouraged to grow and open fetal surgery will hopefully be avoided.

For more information

For questions about this procedure, call the Colorado Fetal Care Center at 855-412-3825.

A close-up of a doctor holding a scope used for fetoscopy.

A fetoscopy is a minimally invasive procedure where a scope is placed in a pregnant woman's uterus under ultrasound guidance. The scope allows specialists to gain visual access to the fetus, uterus, amniotic sac, etc. to determine conditions or rule out concerns. This procedure is conducted in the Fetal Intervention Room and is used for many different fetal conditions, including congenital diaphragmatic hernia (CDH), twin-to-twin transfusion syndrome (TTTS) and amniotic band syndrome.

An interstitial laser is a minimally invasive procedure performed under ultrasound guidance. This intervention is conducted in the Fetal Intervention Room and requires a maternal epidural and sedation. The scope provides visual access to the uterus and helps identify vessels to be ablated (closed). An overnight stay is expected to monitor the mother for contractions. Consistent follow up and ultrasounds are also employed after this procedure to ensure quick recovery.

Radio frequency ablation, or RFA, is a minimally invasive procedure where a needle is placed into the pregnant women's uterus under ultrasound guidance. The needle is used to coagulate vessels present in twin reversed arterial perfusion (TRAP sequence). During this procedure, the mother receives an epidural and IV sedation. An overnight stay in the hospital is expected to assess for contractions.

Shunt placement is a minimally invasive procedure using ultrasound guidance where a drainage shunt is placed into a fetal body cavity, such as the chest or bladder. After it is placed, a shunt will facilitate the removal of fluid so that normal fetal growth can occur. Shunts are often used to treat fetal conditions. Shunt placement may require local or epidural anesthesia, as well as an overnight stay to assess for contractions.

Our dedicated fetal intervention center

As fetal diagnostic capabilities have grown, so too has our experts’ ability to detect and identify fetal anomalies. Today, our fetal surgeons have unparalleled capabilities in diagnosing and performing fetal interventions.

Our facility is specially designed so that moms and their babies with complex needs can both receive comprehensive treatment and care – all under one roof. We offer a single, comfortable space equipped for every aspect of maternal and fetal treatment, from prenatal diagnostic testing and fetal intervention to postpartum care.

The Colorado Fetal Care Center has dedicated rooms for:

  • Labor, delivery and postpartum recovery
  • Infant stabilization
  • Triage
  • Ultrasound
  • Fetal surgery
  • Cesarean delivery (C-section)

Why choose the Colorado Fetal Care Center for your baby’s life-saving fetal intervention?

Our team members are experts in the diagnosis, intervention and treatment of the rarest fetal conditions.

One of Eight Approved FETO trial sites in U.S.
1,200 Fetal surgeries performed
First To perform EXIT to pacemaker for heart block

Unmatched multidisciplinary care

Our fully integrated, multidisciplinary approach to care ensures that every specialist your baby may need is involved from the very beginning – and they all have extensive experience with your child’s condition and the fetal surgery they need. We utilize the knowledge and skills of multiple specialties and providers to create a comprehensive care plan that’s tailored to your child’s needs.

And in the fetal surgery suite, every team member plays their part, contributing in a perfectly coordinated manner to achieve the best possible outcome for your baby.

Improving outcomes at Colorado Fetal Care Center

With state-of-the-art facilities, the latest technologies and extensive experience caring for the highest-risk pregnancies, we consistently achieve some of the best outcomes in the nation. In fact, our physicians, surgeons and researchers have pioneered many maternal and fetal treatments.

Our team works continuously to develop new therapies across the perinatal spectrum. Because of our research and innovations, we offer some of the most innovative fetal therapies available today and continually advance the standard of care for maternal and fetal medicine, which means:

  • Improved outcomes for mothers, fetuses and babies
  • Improving babies’ quality of life by improving their long-term health,
  • Decreasing the risk for high-risk pregnant mothers
  • Giving all babies – even those not yet born – the best chance at a bright, healthy future
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