What is foetal surgery and why do women like Kourtney Kardashian need it?

Kourtney Kardashian, 44, announced she had to undergo foetal surgery in an emotional Instagram post shared Wednesday evening.

In the picture, Kardashian, who is expecting her fourth child, appears to be holding husband Travis Barker’s hand. “I will be forever grateful to my incredible doctors for saving our baby’s life. I am eternally grateful to my husband who rushed to my side…to be with me in the hospital and take care of me afterwards, my rock. And to my mom, thank you for holding my hand through this.”

Kardashian said the foetal surgery was difficult given that her first three pregnancies were without complications. “As someone who has had three really easy pregnancies in the past, I wasn’t prepared for the fear of rushing into urgent fetal surgery,” she wrote. “I don’t think anyone who hasn’t been through a similar situation can begin to understand that feeling of fear. I have a whole new understanding and respect for the mamas who have had to fight for their babies while pregnant.”

Foetal surgery involves performing surgery on an unborn baby (or foetus) while still in the mother’s uterus, per the Mayo Clinic. The procedure is used on foetuses with specific birth defects that can be life-threatening and often worsen as a foetus develops. The goal of the surgery is to improve or treat those birth defects before the child is born. For example, if a doctor detects spina bifida in a foetus, foetal surgery may help the child be “significantly less disabled” than they would have been without the procedure, per the Mayo Clinic.

A number of birth defects can be improved with foetal surgery, including: amniotic band syndrome, congenital cystic adenomatoid malformation (CCAM) of the lung, bronchopulmonary sequestration of the lung, congenital diaphragmatic hernia (CDH), congenital high airway obstruction syndrome (CHAOS), lower urinary tract obstruction (LUTO), foetal anaemia, mediastinal teratoma, sacrococcygeal teratoma (SCT), neck mass, and spina bifida (myelomeningocele), among others. These procedures can be performed by experts who specialise in them at comprehensive health centres.

There are many different foetal surgery procedures used to improve or treat birth defects, including foetal cardiac intervention, shunt placements, and intrauterine blood transfusion.

During foetal surgery, there are risks for both the foetus and the mother. The uterus could rupture after the surgery, and complications could arise during the procedure, as well. Early labour and foetal death are also risks. Additionally, there is a chance foetal surgery won’t be useful, and the birth defect that’s been detected won’t be improved or treated.

Foetal therapy is thought to be “one of the most promising fields in paediatric medicine”, per the Children’s Hospital of Philadelphia. Improved diagnostic tests and foetal imaging have given doctors the tools to recognize when a foetus’s condition is worsening, thus helping them determine when foetal surgery may be helpful.

Kardashian did not disclose why she needed foetal surgery in her Instagram post. She said she was thankful for the medical care she received: “Walking out of the hospital with my baby boy in my tummy and safe was the truest blessing,” she wrote.

Her followers wished her well. Model Winnie Harlow commented on the post, “sending you all the love and prayers of healing.” Actress Alyssa Milano also commented, writing, “Sending you all the strength I can muster. And love. Tons of love.”