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Many centers determine eligibility for innovative procedures using pre\u2010determined inclusion and exclusion criteria based on seminal studies, for example, the \u201cManagement of Myelomeningocele Study\u201d for prenatal MMC repair. What if a person's clinical presentation does not conform to predetermined criteria for maternal\u2010fetal intervention? Does changing criteria on a case\u2010by\u2010case basis (i.e., ad hoc) constitute an innovation in practice and flexible personalized care or transgression of commonly held standards with potential negative consequences? We outline principle\u2010based, bioethically justified answers to these questions using fetal MMC repair as an example. We pay special attention to the historical origins of inclusion and exclusion criteria, risks and benefits to the pregnant person and the fetus, and team dynamics. 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