Invasive fetal therapy

Abstract

Although most prenatally diagnosed anatomic malformations are best managed after birth, we can presently offer prenatal therapy to an increasing number of fetuses with simple anatomical defects that have predictably devastating developmental consequences. A condition amenable to prenatal intervention must fulfill a number of conditions. It must be severe enough to warrant the risks associated with in utero treatment and must be reliably detectable before birth. Furthermore, the pathophysiology must be reversible by fetal intervention, significantly improving the prognosis over postnatal treatment. Current indication for prenatal intervention include decompression for obstructive uropathy, temporary tracheal occlusion for congenital diaphragmatic hernia, and tumor debulking for congenital cystic adenomatoid malformation of the lung and sacrococcygeal teratoma. Prenatal repair of myelomeningocele is currently being developed but remains controversial since this is not a lethal malformation. Maternal safety remains paramount in considering fetal intervention. The main associated risks are pre-term labor and preterm premature rupture of membranes. To reduce maternal morbidity and the risk of prematurity, minimally invasive fetoscopic techniques were developed and are increasingly employed. These developments will in all probability reduce the importance of open fetal surgery in the future.