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For some families, the joy of a new baby comes with unexpected challenges: About 3% of US newborns — roughly 1 in 33 — have a birth defect each year.
While it might seem scary, the good news is that nearly all fetal abnormalities can be detected on prenatal ultrasounds.
Identifying issues early allows parents and doctors to prepare for medical care after birth. And in some cases, doctors can intervene before the baby is born. Thanks to advances in imaging, surgical tools and anesthesia, medical teams can now safely treat a growing number of complex conditions before birth.
Here, I explain the conditions eligible for life-saving fetal surgery and dispel four myths about crucial prenatal screenings.
Ultrasounds aren’t just for finding out the baby’s sex
Ultrasound imaging is vital in monitoring the baby’s development and the mother’s health throughout pregnancy. These powerful diagnostic tools are safe, using high-frequency sound waves, not radiation, to create detailed images and video of the fetus.
Even for women with low-risk pregnancies, routine ultrasounds provide valuable information.
Most patients have two or three scans during pregnancy — one in the first trimester at around 12 weeks, a second detailed anatomy scan between 18 and 22 weeks and another in the third trimester between 28 and 32 weeks.
More may be recommended if concerns arise.
An ultrasound allows us to examine the baby’s brain, heart, chest, abdomen and limbs. In most cases, potential issues can be identified with remarkable accuracy, helping families and care teams plan with confidence.
Still, it’s important to remember that no test is perfect. Some conditions are subtle or develop later in pregnancy, and others may not be fully understood until we do additional imaging, such as a fetal MRI. Experience and careful interpretation are essential.
Abnormal findings don’t always mean bad news
It’s completely natural for parents to feel anxious when something unusual appears on an ultrasound.
At NYU Langone’s Advanced Fetal Care Center, our mission is to provide thorough evaluations, answer every question and outline clear next steps.
A common misconception is that every flagged finding is dangerous. In reality, some results may be false positives due to limitations of the technology or human error.
Others represent conditions that are harmless and resolve on their own. For example, many cysts seen on an ultrasound are completely benign.
Of course, some findings do require closer monitoring or treatment, and we’re here to guide families through each possibility with clarity.
I often meet parents who are terrified after an unexpected finding. My role isn’t just to interpret images; it’s also to help families understand what’s happening and what it means for their baby.
If something serious shows up, there are options
There’s a common myth that when a major malformation is discovered before birth, nothing can be done until delivery.
That’s absolutely not true. Advances in fetal medicine allow us to treat or even correct many serious conditions before a baby is born.
When parents hear there’s a problem, their first question is usually, “Is there anything we can do?” I love being able to say, “Yes, there is.”
Take twin-to-twin transfusion syndrome, a rare but potentially life-threatening condition in which identical twins sharing a placenta exchange blood unevenly.
Just a few decades ago, this diagnosis was almost always fatal.
Nowadays, thanks to minimally invasive surgery performed between 16 and 26 weeks of pregnancy, survival rates for both twins are about 90%.
Most procedures are fetoscopic. Using a tiny camera about a millimeter wide and instruments through small incisions, we can locate and seal the abnormal blood vessel connections on the placenta’s surface, stopping the imbalance.
Another treatable condition is spina bifida, in which an opening in the fetus’ spine exposes delicate nerves and the spinal cord. Some fetuses have devastating postnatal outcomes, from walking difficulties to excess fluid buildup in the brain.
Through three small incisions in the mother’s uterus, we insert a tiny camera and instruments to carefully repair and close the defect and protect the nerves, which can dramatically improve long-term outcomes, including mobility and brain development.
We can also intervene in certain heart defects and congenital diaphragmatic hernia, in which abdominal organs move into the chest and affect lung development.
What once felt unimaginable is now part of standard care at a select number of centers across the country, changing outcomes every day.
Fetal surgery isn’t experimental anymore
While the idea of surgery before birth can sound intimidating, advances in technology and expertise have made these procedures remarkably safe and effective for many complex conditions.
Although all surgery carries some risk, minimally invasive fetal techniques can significantly reduce complications for mother and baby.
Depending on the diagnosis, we may temporarily open the uterus or perform a fetoscopic procedure that is less invasive.
Each case is managed by a multidisciplinary team that includes pediatric surgeons, maternal-fetal medicine specialists, anesthesiologists and more, working together to ensure the safest care possible.
That said, fetal surgery isn’t right for every situation.
In some cases, the best course of action may be to wait until after delivery or to plan for an earlier birth under specialized care.
That’s why a comprehensive evaluation and individualized prenatal plan are essential.
We’re one of fewer than 10 centers in the US offering these highly specialized procedures. Our team is deeply committed to innovation, with access to new clinical trials, research studies and cutting-edge devices that continually expand what’s possible.
Every pregnancy is unique, and the earlier families connect with a specialized fetal center, the more options we have and the better chances for a healthy outcome. Before losing hope, families should reach out to the Advanced Fetal Care Center to explore the full range of care available.
Jose L. Peiro Ibanez, MD, Ph. D., is a professor in the Department of Surgery, Division of Pediatric Surgery at the NYU Grossman School of Medicine and director of NYU Langone’s Advanced Fetal Care Center. A fetal and neonatal surgeon who recently joined Hassenfeld Children’s Hospital at NYU Langone, Peiro brings extensive experience performing lifesaving surgery on babies before and immediately after they are born.
