Maternal-Fetal Surgery: Trade-off Examples

One of the key parts of healthcare is the need to make tradeoffs especially when it comes to treatment plans. Exercise requires a commitment and can make you sore. Some drugs have side effects that may impact other parts of the patient’s life. Surgeries carry risk.

With that in mind, I found an article in the American Way magazine interesting in its discussion of maternal-fetal surgery. This is a technique where a doctor uses a fetoscope (telescope with a small camera at the end) to go into the uterus through a tiny incision (0.15 inches wide) to stabilize life-threatening blood-supply imbalances (e.g., twin-twin transfusion syndrome) and through larger incisions to remove rapidly growing and life threatening tumor masses. As you can imagine, this is controversial. There are risks for the mother and no guarantees that it will be successful.

There were less than 1,000 surgeries between 2005 and 2006, and it sounds like it is used for extreme cases today (i.e., less than 10-20% chance of the fetus living). A clear example of why transparent information is necessary and clear communications make a difference. Patients need to understand their options, the risks, the tradeoffs, and the implications.