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BackTable / OBGYN / Article
The Road to Fetal Intervention: Training Pathways & Practical Advice
Audrey Qian • Updated Sep 26, 2025 • 37 hits
Fetal intervention focuses on treating and managing birth defects or pregnancy complications to increase chances of survival and improve long-term outcomes. The field encompasses a broad range of procedures – from intrauterine transfusions to fetoscopic laser ablation and open surgical repair – requiring advanced technical expertise and coordinated multidisciplinary care. Although a highly specialized field with limited opportunities for training, fetal intervention continues to have growing interest, driven largely by ongoing research and the promise of more minimally invasive approaches for treatment and management.
Maternal-fetal medicine specialist and fetal interventionalist Dr. Hiba Mustafa covers the scope of fetal intervention while sharing insights from her training, career path, and strategies for success in the field. This article features excerpts from the BackTable OBGYN Podcast. We’ve provided the highlight reel in this article, but you can listen to the full podcast below.
The BackTable OBGYN Brief
• Fetal interventionalists may enter the field through obstetrics or through pediatric surgery, with each pathway shaping procedural expertise. Dr. Hiba Mustafa was personally drawn to the field through exposure to advanced procedures during her residency and her fascination with ultrasounds.
• Unlike OB/GYN or maternal fetal medicine (MFM) programs, fetal surgery fellowships lack ACGME accreditation, with training varying by institution. There are only a few U.S. centers that can offer the training, and those positions are only intermittently available, making mentorship, networking, and proactive engagement essential to securing opportunities.
• Technical mastery in fetal intervention depends not only on individual skill but also on coordinated team readiness. At Riley Children’s Health, strategies such as pre-op virtual walkthroughs, post-op debriefings, and protocol checklists help standardize care and enhance team performance.
• Fetal intervention is advancing toward minimally invasive approaches and exploring prenatal gene and stem cell therapies for genetic disorders.
Table of Contents
(1) Fetal Intervention Clinical Training Pathways
(2) Fellowship Access for Fetal Intervention Training
(3) Maintaining Individual & Team Procedural Competence in Fetal Intervention
(4) Looking to the Future of Fetal Intervention
Fetal Intervention Clinical Training Pathways
Fetal interventionists – occasionally referred to as fetal surgeons or fetal therapists – are specialists trained to manage high-risk pregnancies complicated by fetal abnormalities that threaten survival or cause severe morbidity after birth. Clinicians may enter the field through two primary routes: an obstetrics pathway or a surgical pathway. While an obstetrics route typically involves OG/BYN residency followed by maternal-fetal medicine and fetal surgery fellowships, a surgical route begins with pediatric surgery before culminating in fetal surgery training.
Each route influences the breadth and type of procedures performed. In Dr. Hiba Mustafa’s case, exposure to advanced procedures – such as laser ablation for twin-to-twin transfusion syndrome – during her residency inspired her to pursue this specialized field. Additionally, her strong interest in ultrasound, a cornerstone for diagnosis and intervention in fetal medicine, made the field even more fascinating for her. This variety in scope and technical focus can be a strong draw for aspiring physicians while adding a lot of technical nuance and procedural techniques to the practices of already established surgeons.
[Dr. Anthony Shanks]
The reason why you were featured was because you're a fetal interventionalist. For people that are watching this or listening to this, they may not know what that is. Can you tell us what a fetal interventionist is, and maybe share what that story was that they made the video of?
[Dr. Hiba Mustafa]
Yes. The naming has been variable across different institutions. Fetal interventionist, or fetal surgeon, or fetal therapist, some people would call it, is a person who finished certain type of training. I'll talk about the routes you can go to that training. It focuses on pregnancies, high-risk pregnancies, in which they encounter certain complications during pregnancy related particularly to the fetus.
If the fetus has a certain condition, abnormality, that affects either their survival or causes severe morbidity after birth, then the fetal interventionist or the therapist might be able to intervene in certain ways, certain time of pregnancy if they are eligible. Most importantly, if benefits outweigh the risks, to either improve survival or hopefully reduce the morbidity of that condition.
[Dr. Anthony Shanks]
Hiba, could you tell us about your training and when exactly you got interested in focusing on something that is so specialized?
[Dr. Hiba Mustafa]
Yes. I'm OB/GYN. Residency, OB/GYN residency. I did my maternal fetal medicine fellowship. Maternal fetal medicine, people know it as high-risk OB specialists. You focus whether it's mom or the baby have like some certain complications in pregnancy. After the maternal fetal medicine or MFM fellowship, I did the fetal surgery fellowship. OB/GYN residency is four years, MFM fellowship is three years, and then extra two years for fetal surgery fellowship.
There's another route for it. People might go, which is through the surgical route. You do pediatric surgery, and then you do two years of fetal surgery fellowship. Might be a little bit different of what type of procedures you do, like how extensive, how big of a spectrum you can do if you go through the surgical route versus if you go through the MFM route kind of thing.
[Dr. Anthony Shanks]
With your own journey, when in residency, did you decide MFM? When within MFM, did you decide fetal interventionist versus just MFM?
[Dr. Hiba Mustafa]
No, actually, I think it started in residency. I was a resident in New York, Mount Sinai, New York, and then there was a person who came from CHOP, and they did a lecture to the residents. The lecture was about the twin-twin transfusion syndrome. Basically, if the patients that they did laser on and they ended up coming back to us, they wanted us to send the placentas back to them to do dye test. Basically, during this condition, there's like vascular connections between twins, and with the laser, you can burn these vascular connections.
They wanted to look at the placentas after birth and inject dyes into those vessels just to see if they missed any vessels or how it's looking. I was just a resident full of energy, full of hopes and dreams. Then this person comes and talks about something that, to me personally, appeared so fascinating and so intriguing. That's when I think I want to be a fetal surgeon. I think why it was fascinating more to me that I wanted to take it as a career rather than other people. I was a person who was really into ultrasound.
This is uncommon among OB/GYN residents that they allocate part of their residency time on ultrasound because they're exhausted, they're doing so many rotations. I actually spent a lot of electives, a lot of my off time. If I have nothing to do, I'll go to the ultrasound unit. Something about ultrasound that always I loved to learn more about. Of any fetal interventionist, ultrasound is the biggest portion of their career kind of thing. I think just my love to the ultrasound made this field just more fascinating to me. I thought I can be like that person who was giving the lecture one day.
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Fellowship Access for Fetal Intervention Training
Unlike OB/GYN or maternal-fetal medicine (MFM) fellowships, fetal surgery fellowships are not ACGME-accredited, leaving training structure, case exposure, and research requirements dependent on individual institutions. While completing an MFM fellowship at a center that offers fetal intervention may offer valuable experiences, it is not a prerequisite for pursuing the specialty. Instead, fellows may sign up for electives, listen to lectures, and learn the pathophysiology and techniques.
Unfortunately, fetal surgery fellowships are limited, as only a handful of U.S. programs – Texas Children’s, UT Houston, Cincinnati Children’s, and Children Hospital of Philadelphia – intermittently accept fellows based on funding and institutional needs. Since fellowship availability is not consistently open, networking and mentorship have become particularly important in securing training opportunities.
[Dr. Anthony Shanks]
You know me for the audience members. I'm big into education, both medical student and residency. People listening to this, they've done residency. They know that process of applying it and matching. Then, for those that specialize in, we know what that application process looks like in the training. You did another-- just it continues to be specialized. How did you identify where to train, and what did the training actually look like after MFM fellowship?
[Dr. Hiba Mustafa]
For those people who are really into fetal intervention, it's definitely a good thing to do your MFM fellowship in a place that does offer that. However, like after finishing my MFM fellowship, I did realize it's not necessarily true. That's how many MFM fellows approach me. When we go to SMFM or I go to any meeting, those who are interested into the field, they come and they say, "Oh, I do my training in somewhere that they don't offer fetal intervention. Is that a disadvantage to me or not?"
I say absolutely not a disadvantage because those places who are like have a big program and they offer fellowships, et cetera, it's more focused on the team that does the fetal surgery. Usually they have a fetal intervention fellow who come to those cases, and the MFM fellows involvement might not be as big even if you get involved because you're not planning to take this as a career. They might not invest a lot of time, if that makes sense, rather than investing more time into their fetal intervention fellow.
Yes, there is definitely an advantage from seeing those cases, managing them pre-op, managing them post-op, but I don't want this to hinder MFM fellows from embarking on this step just because they did their fellowship somewhere that it does not do fetal intervention. Otherwise, I always say, "Go do electives at those places, and attend meetings, and listen to lectures, and read about these topics. Learn the pathophysiology and the offerings and the techniques, et cetera, because your main training is going to come during your fetal surgery fellowship."
That's the time where people will be really focused on training you, letting you do it with your own hands, and letting you scan, and letting you make decisions. Yes, it's great if you do your MFM fellowship somewhere who offers it, but never feel disappointed if you match into a place that doesn't necessarily offer it because your main goal when you go to MFM fellowship is MFM. That's why I always say when you go to OB/GYN residency, even if you like MIGS or Gynaec or whatever, focus on being an OB/GYN resident.
Learn the whole field, learn the whole spectrum, learn everything about L&D. Even if you don't like so much being on L&D, but eventually when you become more of a senior resident, you can spend more electives and research on the place that you like to end up with. Similarly, for MFM fellowship, you entered MFM for an MFM. Learn the whole spectrum of MFM because you're going to manage those patients as a whole.
I have a patient whom I'm managing her for fetal reasons, but I have to manage her diabetes and hypertension and everything else. Basically, if you end up in a fellowship that does not offer it, don't feel disappointed. You're going to do still great. You're still going to end up matching hopefully, into fetal surgery fellowships or find a place that's willing to train you and help you grow kind of thing.
[Dr. Anthony Shanks]
What does the landscape look like? I'm familiar with how many maternal fetal medicine fellowships there are in the country, and you don't have to have a very specific number. What does it look like? How many places both in the US and internationally are training people for this?
[Dr. Hiba Mustafa]
Very few. Probably people know this, or maybe they don't know, this is not a ACGME-approved fellowship. There's no certain guidelines or how should it look like. The way it looks is per institution. The amount of years you do per institution, the cases that you do in your first year or second year, and how much research they require you to do is purely per institution. Even those institutions who offer the fellowship, generally they offer it for two years. Some of them decide to do, I'm not going to take another fellow until my fellow finishes the two years.
Some of them know they would take a fellow every year. Some of them they lose their funding because this is not like residency or MFM fellowship is not federally funded. The institution they have to find funds for that position. They might lose funds over certain years, so they don't offer it. Basically, generally, generally the people or the institutions who've been out there, it's Texas Children, Baylor in Texas, UT Houston, which is Memorial Children in Texas as well. Children Hospital of Philadelphia, they have been on and off.
This year they're taking a fellow, but they've been not taking for a few years, for example. Then you have Cincinnati Children, also on and off. They took a fellow today who used to be my resident, but certain years they might not take. However, there are places who want to take a fellow, for example, to train and keep them as partners, for example. I always say, like, "Don't feel like those places who offer fellowship would be your only options. Absolutely not. Go to the meetings, show yourself, show that you are a person who are interested into this field."
Present yourself as a person who, if they're willing to take a fellow one day or help train someone to become their partner, you are available. Don't feel like those places and websites generally, for MFM Fellowship, OB/GYN residency, we go to Google, and we look on the website. This is not something you necessarily will see on websites. This is more of a verbal communication you know someone. You heard someone is offering a fellowship kind of thing. Always be there, present yourself, show your enthusiasm and interest, and people will reach out to you.
Maintaining Individual & Team Procedural Competence in Fetal Intervention
In addition to continuous education and training, sustaining technical proficiency and medical knowledge in fetal intervention requires not only individual aptitude and learning curve but also coordinated team readiness. Technically demanding procedures like those performed by fetal interventionists require a coordinated effort from attendings, fellows, nurses, anesthesiologists, and techs. At Riley Children’s Health in particular, the fetal intervention team adopts various strategies to maintain performance. Some of these include preoperative virtual walkthroughs to review protocols and expectations, postoperative debriefings to identify areas of improvement and update protocols, and documentation checklists to ensure consistency. Regular structured review reduces variability from staff changes and supports safe, standardized care.
[Dr. Anthony Shanks]
You do a lot of fetal blood transfusions. Then I know just because I know you, the lasers come up. Then, fortunately, some of these other interventionalists, because they're more rare, they don't happen quite as often. How do you stay sharp with all of these things? Do you think that there is a magic number that people need to do to stay up to date with their skills?
[Dr. Hiba Mustafa]
Yes, that's very interesting question. I think it varies a lot by the person like themselves. Just like when we get a new resident, if you have four residents, you have one resident who can do sections quicker than her co-residents, for example, or his co-residents. It just varies by person, how fast they pick their skills, how good they maintain them, and how much they need to maintain them. For lasers, I think that research or survey that NAFNA did, I think it said 12 to 15 per year for laser procedures. For MMC, I don't think there is any data out there, honestly.
In our institution, as of now, this is like a new approach we've offered for a few months now. It's been like once every two weeks, I would say once every three weeks. Regardless, it's not only my skills that I worry about in complete honesty, it's the team. You need your nursing team, you need your anesthesia team. It's a whole teamwork and you need your fellow to help you in certain things as well. No matter how confident I am in myself, I want to make sure my team still know the plan and still remember the plan. We have a lot of techs, a lot of nurses, and they might circulate it through cases.
For our particular institution, the way we do it, before a case, we do a virtual walkthrough in which we have the nursing, the anesthesiologist just join a virtual call for 30 minutes and just go over the checklist and protocol. We decided to do this at least for the first few years, just to make sure that if your nurse changed or if your scrub tech changed or whatever debrief-- we do debriefing after every case. Sometimes we change our protocols based on that debriefing.
We just want to make sure everyone is still on track and up to date with how we do these procedures, what is needed from each team member during these procedures. I think it just takes a lot of pressure from your team by, oh yes, we talked about it. I feel good, I feel confident. I know how the scrub tech, I know how to set my tables the way you guys want. The nurse, I know what you want me to document. They have a sheet, they document many multiple points. and the OR I know what to document. It's not only the surgeon, I think it's the whole team in complete honesty.
Looking to the Future of Fetal Intervention
Among physicians in the field there are many who hope for the trajectory of fetal intervention to move toward increasingly minimally invasive approaches, with the goal of reducing maternal morbidity while optimizing outcomes for newborns. Emerging therapies under investigation include prenatal intervention for obstructive hydrocephalus to relieve cortical pressure to improve neurodevelopment and prenatal repair of encephaloceles in South American to reduce microcephaly and long-term impairment. In parallel, advances in prenatal gene and stem cell therapies show promise in managing genetic conditions like mucopolysaccharidoses but remain largely experimental.
Beyond technical innovation, Dr. Mustafa explains that research enriches clinical practice and sustains professional fulfillment, while emphasizing that effective teamwork makes balancing a demanding clinical and research career much more feasible.
[Dr. Anthony Shanks]
What do you see in the immediate future for fetal therapists? Any new cases that are on the horizon, new types of interventions that you can be using? What do you think's coming?
[Dr. Hiba Mustafa]
I really hope we get more minimally invasive as we go through the years. That's like, you hear those, like you read about these cases, and you might even see videos of cases where people did like, for example, big open exits for certain tumors or certain things. You see those cases are becoming almost none and nonexistent and super rare now. As a fetal interventionist, we realize the importance of becoming more and more minimally invasive. If I can do a procedure with just a needle, that's great. If I can do it with like certain medication, that's even better.
Some of the therapies out there that are currently under research, but I think it might become a thing, is prenatal intervention for hydrocephalus. There have been a lot of research done into looking at long-term outcomes for babies with obstructive hydrocephalus, which is frequently due to aqueductal stenosis, and they have poor neurodevelopmental outcomes. The idea is if you relieve that pressure on the cortex early enough in pregnancy, you might improve those outcomes. This is out there strongly, and people are trying to get it into clinical practice.
It's still in animal research. Another thing is still in animal research, but I would say that's more of South America, not other places, is they've been trying to look at encephaloceles. Encephaloceles, they found that if they manage certain of them prenatally, they're reducing the chances of microcephaly and long-term neurodevelopmental impairment. That's just in the Latin America few centers they looked at it. There's, as I mentioned, medical therapy.
There's a lot of research currently done on gene therapy, and stem cell therapy, and medical therapy for multiple conditions. The researcher in UCSF is looking at, for example, mucopolysaccharidoses and those treatments that you can do prenatally, so gene and stem cell therapy, stuff like that. This is all still under research, but every now and then you hear one clinical case coming out as case report kind of thing.
[Dr. Anthony Shanks]
Very cool. My last question for you. I crowdsourced this from our fellows when I mentioned that I was going to get a chance to talk to you…They have a great deal of respect for you in the clinic. Certainly the fetal interventions and research, and they're just in awe of your productivity. How do you juggle it? What advice do you have?
[Dr. Hiba Mustafa]
I love our fellows. I have to say a lot is thanks to them. They're just an amazing group of fellows. Dr. Shanks, you did an amazing job of setting them to fellowship and getting them to be our fellows. They are a huge part of fetal intervention and ultrasound clinic. I rely a lot on them on getting the patient to the OR, assisting in the OR, and making sure she gets proper follow-up and management afterwards. I wouldn't be able to do it at all without them. They're also involved in our placenta accreta cases, which is another topic for another day.
Thanks to them, I've been able to finish my day doing interventions and seeing a clinic. When it comes to research, a lot of people do ask me that. I'm like hired as mainly clinical and I don't necessarily have allocated research time. I do my research. If I don't have a case, I sit and finish my work or after work or et cetera. I tell people research is what keeps my heart pumping. It's just I love research. It helps me understand what I do for my patients better and helps me become a better practitioner. It's the fun part of what I do.
Podcast Contributors
Cite This Podcast
BackTable, LLC (Producer). (2025, June 17). Ep. 86 – Understanding Fetal & Maternal Interventions: Procedures & Outcomes [Audio podcast]. Retrieved from https://www.backtable.com
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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