Does Open Fetal Surgery Affect Future Pregnancies?

Yes, open fetal surgery for spina bifida does impact your ability to manage future pregnancies. Balancing the health of your current baby with your hopes for future children is an incredibly heavy decision to make. Because the procedure involves making an incision through the wall of your uterus (a hysterotomy) to reach the baby, it leaves a permanent scar. While many women go on to have healthy pregnancies after fetal surgery, this scar means that all future pregnancies—and the delivery of your current baby—will require specialized monitoring and a different delivery plan.

The Uterine Scar and Healing

During open fetal surgery, the surgeon typically makes a “classical” or vertical incision in the active, contracting part of the uterus. This is different from the lower, horizontal incision used in most routine C-sections.

As a result, the scar left behind carries a significant risk of uterine dehiscence (where the scar begins to separate or thin out) or uterine rupture (where the scar opens) during a future pregnancy ^[1][2]. Research indicates that the risk of the scar separating in pregnancies following open fetal surgery is similar to the risk seen in women who have had a classical C-section ^[1].

Because classical scars can be unpredictable as they stretch, your future pregnancies will need to be closely followed by a maternal-fetal medicine specialist. Your doctor will use advanced ultrasound to monitor your uterus and ensure you and your baby remain safe.

Waiting Period Before Conceiving Again

If you undergo open fetal surgery, you must wait a specific healing period before trying to conceive your next child ^[3]. Getting pregnant before the uterine tissue has fully healed can increase the risk of complications.

While there is no single universal timeline for exactly how many months you must wait ^[4], your surgical team will give you a personalized recommendation. They will usually advise waiting an extended period (often 18 to 24 months, or longer) to ensure your uterus has had maximal time to recover. It is highly recommended to consult your maternal-fetal medicine specialist for a preconception assessment before you start trying to conceive again.

Delivery of Future Pregnancies

To keep you and your future babies safe, your medical team will change how you deliver. Because the strong contractions of natural labor put physical stress on the uterus, laboring with a classical hysterotomy scar is not considered safe ^[2].

Therefore, all future pregnancies must be delivered by a scheduled C-section before the onset of natural labor ^[1][2]. By scheduling the delivery early—typically around 36 to 37 weeks, before natural labor might begin—your care team ensures that you do not experience the strong contractions that could put stress on your scar. (Note: This also applies to your current pregnancy; your baby will be delivered via a scheduled C-section after the fetal surgery.)

(Note: Newer, minimally invasive approaches like fetoscopic repair are being studied and may offer a lower risk of uterine dehiscence compared to open surgery, though they carry their own unique risks ^[5]. Your eligibility for these alternatives depends on your specific medical situation.)