Routine obstetric sonography has changed the management of many congenital anomalies. The early detection of a structural lesion may influence the timing, mode, and location of the delivery. Delivery can be planned at a center with neonatal intensive care and pediatric surgical expertise. Prenatal sonography particularly has affected the surgical management of congenital anomalies. Although most correctable malformations diagnosed in utero are still best managed by appropriate postnatal medical and surgical therapy, in selected cases, treatment before birth with fetal surgery may be the best option (Table 1)

Many congenital structural malformations have debilitating or lethal consequences in the fetus or neonate. An intrauterine fetal demise, stillborn child, and a severely affected neonate requiring prolonged intensive care are concrete evidence that treating some life-threatening problems postnatally is too late to be effective. The allure of fetal surgery is the possibility of interrupting the progression of an otherwise devastating fetal disease. The major hurdles for the development of fetal surgery have been defining patient selection criteria, crafting effective fetal surgical techniques, devising fetal and uterine monitoring, generating new strategies for tocolytic management, and minimizing maternal and fetal risk.