Anesthesia for intrapartum fetal surgery

Intrapartum fetal surgery is a growing field with many new procedures being developed that can improve neonatal outcomes for a variety of pathologies. These are typically only performed at advanced centers due to the complexity of the procedures themselves and the necessary multidisciplinary approach. While some procedures can be performed with local anesthesia and sedation, others require complex management plans involving general anesthesia. There is significant variation in practice between institutions. As some of these procedures may be performed later in gestation, it is important to understand the physiologic changes in pregnancy and the fetus in utero. There are risks to both the mother and fetus, and it is important to appreciate and understand how to optimize both while providing optimal surgical conditions.