Fetal surgery: principles, indications, and evidence

Obstetrics and Gynecology
Katharine D Wenstrom, Stephen R Carr

Abstract

Since the first human fetal surgery was reported in 1965, several different fetal surgical procedures have been developed and perfected, resulting in significantly improved outcomes for many fetuses. The currently accepted list of fetal conditions for which antenatal surgery is considered include lower urinary tract obstruction, twin-twin transfusion syndrome, myelomeningocele, congenital diaphragmatic hernia, neck masses occluding the trachea, and tumors such as congenital cystic adenomatoid malformation or sacrococcygeal teratoma when associated with developing fetal hydrops. Until recently, it has been difficult to determine the true benefits of several fetal surgeries because outcomes were reported as uncontrolled case series. However, several prospective randomized trials have been attempted and others are ongoing, supporting a more evidence-based approach to antenatal intervention. Problems that have yet to be completely overcome include the inability to identify ideal fetal candidates for antenatal intervention, to determine the optimal timing of intervention, and to prevent preterm birth after fetal surgery. Confronting a fetal abnormality raises unique and complex issues for the family. For this reason, in addition to ...Continue Reading

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Related Concepts

Congenital Abnormality
Embryopathies
Pregnancy Outcome
Antenatal Screening Procedures
Obstetric Surgical Procedures
Fetal Ultrasonography
Benefit-Risk Assessment
Selection of Subjects
Surgical Procedures, Minimally Invasive
Evidence-Based Medicine

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