The first description of open maternal-fetal surgery for correction of anatomic anomalies by Harrison was published three decades ago (Adzick 2003). At that time, the diagnostic and surgical tools for prenatal treatment of the fetus were just being developed, and the concept of the fetus as a patient was the subject of philosophical and ethical debate. Since then, great progress has been made in the ability to diagnose fetal abnormalities, predict their outcome, and perform surgical interventions when appropriate. The concept of the fetus as a patient has become a standard of care, and the ethical framework for maternal-fetal intervention is well developed (Adzick, Semin Fetal Neonatal Med 15(1):1–8, 2010). While application of open fetal surgery has remained limited to a relatively small number of highly selected fetuses and is practiced in only a few centers, the development of this field has accelerated technological progress in prenatal diagnosis and intervention, led to improved understanding of the pathophysiology and natural history of candidate disorders, allowed comprehensive counseling of parents in centers with focused expertise in fetal anomalies, and driven the evolution of less invasive therapeutic approaches. The purpose of this chapter is to describe the current status of fetal surgical intervention and to speculate regarding future developments in this rapidly evolving field.
Fetal surgery Fetoscopy Ex utero intrapartum therapy Congenital cystic adenomatous malformation Congenital diaphragmatic hernia Myelomeningocele Sacrococcygeal teratoma Twin-to-twin transfusion syndrome
This is a preview of subscription content, log in to check access.
Deprest J, Nicolaides K, Done’ E, et al. Technical aspects of fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia. J Pediatr Surg. 2011;46:22–32.CrossRefPubMedGoogle Scholar
Flake AW, Crombleholme TM, Johnson MP, et al. Treatment of severe congenital diaphragmatic hernia by fetal tracheal occlusion: clinical experience with fifteen cases. Am J Obstet Gynecol. 2000;183:1059–66.CrossRefPubMedGoogle Scholar
Geaghan SM. Fetal laboratory medicine: on the frontier of maternal-fetal medicine. Clin Chem. 2012;58(2):337–52.CrossRefPubMedGoogle Scholar
Golombeck K, Ball RH, Lee H, et al. Maternal morbidity after maternal-fetal surgery. Am J Obstet Gynecol. 2006;194(3):834–9.CrossRefPubMedGoogle Scholar
Harrison MR, Golbus MS, Filly RA, et al. Fetal surgery for congenital hydronephrosis. N Engl J Med. 1982;306:591–3.CrossRefPubMedGoogle Scholar
Harrison MR, Adzick NS, Bullard KM, et al. Correction of congenital diaphragmatic hernia in utero VII: a prospective trial. J Pediatr Surg. 1997;32:1637–42.CrossRefPubMedGoogle Scholar
Quintero RA, Morales WJ, Allen MH, et al. Staging of twin-twin transfusion syndrome. J Perinatol. 1999;19(8 Pt 1):550–5.CrossRefPubMedGoogle Scholar
Roybal JL, Moldenhauer MS, Khalek N, et al. Early delivery as an alternative management strategy for selected high-risk fetal sacrococcygeal teratomas. J Pediatr Surg. 2011;46:1325–32.CrossRefPubMedGoogle Scholar
Rychik J, Tian Z, Bebbington M, et al. The twin-twin transfusion syndrome: spectrum of cardiovascular abnormality and development of a cardiovascular score to assess severity of disease. Am J Obstet Gynecol. 2007;197(4):392.e1–8.CrossRefGoogle Scholar
Senat MV, Deprest J, Boulvain M, et al. Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med. 2004;351:136–44.CrossRefPubMedGoogle Scholar
van Klink JM, Koopman HM, Rijken M, Middeldorp JM, Oepkes D, Lopriore E. Long-term neurodevelopmental outcome in survivors of Twin-to-Twin Transfusion Syndrome. Twin Res Hum Genet. 2016;19(3):255–61.CrossRefPubMedGoogle Scholar
Wilson RD, Johnson MP, Flake AW, et al. Reproductive outcomes after pregnancy complicated by maternal-fetal surgery. Am J Obstet Gynecol. 2004;191(4):1430–6.CrossRefPubMedGoogle Scholar