Fetal surgery is a highly specialized medical discipline dedicated to treating birth defects and complex conditions in an unborn baby while they are still in the womb. This advanced level of prenatal care offers interventions for conditions that would otherwise cause severe disability or death if left untreated until after birth. Because these procedures are technically demanding, carry risks to both the mother and the fetus, and require extensive infrastructure, fetal surgery remains an exceptionally rare medical subspecialty globally. The small number of practitioners reflects the rigorous training and the concentration of these services in only a few high-level medical centers worldwide.
Global Estimates of Fetal Surgeons
A precise, real-time count of practicing fetal surgeons is not maintained globally due to the lack of a single international medical credentialing body. The most reliable way to gauge the field’s size is by counting the specialized medical centers that offer advanced fetal intervention. For instance, approximately 37 medical centers in the United States are equipped to perform advanced in-utero therapeutic procedures. The North American Fetal Therapy Network (NAFTNet) lists over 50 member institutions. Attendance at the annual meeting of the International Fetal Medicine and Surgery Society (IFMSS) often includes just over 200 scientific participants, which serves as a proxy for the core group of experts in the field. Given the extreme resource requirements and the small number of centers, the total number of dedicated, actively practicing fetal surgeons is likely only in the low hundreds globally.
Distinct Role of the Fetal Surgeon
The fetal surgeon’s role is distinct from that of a Maternal-Fetal Medicine (MFM) specialist, who primarily manages high-risk pregnancies but may not perform complex invasive procedures. The fetal surgeon is specifically responsible for executing the operative intervention on the fetus or the placenta while the baby remains in the uterus. This requires working within a sterile, controlled environment using specialized instruments, often while the mother is under anesthesia.
The procedures performed fall into three main categories: open fetal surgery, fetoscopic surgery, and percutaneous fetal therapy.
Open Fetal Surgery
This involves a hysterotomy, where the uterus is opened to directly access and operate on the fetus, such as in the repair of myelomeningocele, the most severe form of spina bifida.
Fetoscopic Surgery
This is minimally invasive, using small incisions to insert a fetoscope (a tiny camera and instruments) to perform delicate procedures like laser ablation for twin-to-twin transfusion syndrome (TTTS).
Percutaneous Fetal Therapy
These procedures involve inserting needles or catheters through the maternal abdomen and uterine wall under continuous ultrasound guidance to drain fluid or place shunts.
Life-saving interventions also include fetoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia (CDH) and the resection of large sacrococcygeal teratoma tumors. Each surgery is a collaborative effort, involving a multidisciplinary team of MFM specialists, pediatric surgeons, neonatologists, and anesthesiologists. The surgeon must balance the therapeutic benefit to the fetus against the potential risks to the mother, such as preterm labor and future uterine complications.
Specialized Training and Subspecialty Requirements
The journey to becoming a fetal surgeon is one of the longest and most rigorous in medicine, typically spanning over a decade of post-medical school training. Candidates generally follow one of two primary educational paths, both demanding extensive surgical and prenatal expertise.
General Surgery Pathway
This path begins with a five-year residency in General Surgery, followed by a two-year fellowship in Pediatric Surgery. This provides the comprehensive surgical background needed for complex pediatric procedures. The surgeon then completes an additional one- to two-year specialized fellowship focused entirely on fetal diagnosis, therapy, and surgery.
Obstetrics and Gynecology Pathway
This path starts with a four-year residency in Obstetrics and Gynecology, followed by a three-year fellowship in Maternal-Fetal Medicine (MFM). After MFM training, the surgeon must still pursue a dedicated surgical fellowship or additional specialized training to gain the necessary operative skills. This lengthy and competitive training process is a major factor contributing to the low number of practicing fetal surgeons.
Disparities in Global Access
The scarcity of fetal surgeons and the concentration of advanced fetal care centers create significant disparities in global access to these life-altering procedures. The vast majority of established fetal surgery programs are located in high-income countries, primarily within North America and Western Europe. This geographic clustering means that patients in large parts of the world, including most of Africa, South Asia, and many areas of South America, lack local access to specialized prenatal intervention.
For families without a nearby fetal center, receiving treatment often requires complex, expensive medical travel over long distances. Even within high-income countries, this concentration results in domestic access issues, creating “fetal care deserts.” These are regions where women live more than 100 miles away from a recognized fetal therapy center, disproportionately affecting rural and lower-income populations. The uneven distribution of this specialized workforce directly impacts global health equity.