Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-669899f699-vbsjw Total loading time: 0 Render date: 2025-05-05T20:08:43.526Z Has data issue: false hasContentIssue false

Chapter 13 - Invasive Fetal Therapies

from Section 3 - Fetal Medicine

Published online by Cambridge University Press:  20 November 2021

By
Catherine E. Aiken  and
Jeremy Brockelsby
Edited by
Tahir Mahmood ,
Charles Savona Ventura ,
Ioannis Messinis  and
Sambit Mukhopadhyay
Tahir Mahmood
Affiliation:
Victoria Hospital, Kirkcaldy
Charles Savona Ventura
Affiliation:
University of Malta, Malta
Ioannis Messinis
Affiliation:
University of Thessaly, Greece
Sambit Mukhopadhyay
Affiliation:
Norfolk & Norwich University Hospital, UK
Get access

Summary

In recent years, there has been an upsurge of interest in therapeutic intervention for fetal benefit prior to delivery. The main drivers of the increasing tendency towards intrauterine intervention are improving imaging techniques, increasing confidence and experience of global centres with fetal therapies and wider developments in the field of minimally invasive surgery. The accelerating trend for trialling new fetal therapies means that careful consideration of the overall benefit of intrauterine intervention is required. Any therapy performed for fetal benefit during pregnancy inherently requires consideration of maternal risks, whereas delaying intervention until after delivery avoids maternal complications. Therapies performed after birth are also technically easier; the baby is larger, surgical access is easier and appropriate anaesthesia can be assured. An additional risk of fetal therapy is of provoking preterm delivery, and hence complicating a precarious clinical condition with the additional burden of prematurity. Even if preterm delivery does not occur, there is still the hurdle of delivery itself to be overcome after definitive therapy has been performed. In view of these significant advantages associated with post-delivery interventions, it is vital to ensure that the benefits of intervening for fetal benefit during pregnancy truly outweigh the risks.

Type
Chapter
Information
The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
Obstetrics & Maternal-Fetal Medicine
 , pp. 109 - 116
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Society for Maternal-Fetal Medicine; Mari, G, Norton, ME, Stone, J, et al. Society for Maternal-Fetal Medicine (SMFM) Clinical Guideline #8: the fetus at risk for anemia–diagnosis and management. Am J Obstet Gynecol. 2015 Jun;212(6):697–710.CrossRefGoogle Scholar
Moise, KJ. Fetal anemia due to non-Rhesus-D red-cell alloimmunization. Semin Fetal Neonatal Med. 2008 Aug;13(4):207–14.Google Scholar
Mari, G, Deter, RL, Carpenter, RL, et al. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses. N Engl J Med. 2000 Jan 6;342(1):9–14.Google Scholar
Moise, KJ Jr., Argoti, PS. Management and prevention of red cell alloimmunization in pregnancy: a systematic review. Obstet Gynecol. 2012 Nov;120(5):1132–9.Google Scholar
Fox, C, Martin, W, Somerset, DA, Thompson, PJ, Kilby, MD. Early intraperitoneal transfusion and adjuvant maternal immunoglobulin therapy in the treatment of severe red cell alloimmunization prior to fetal intravascular transfusion. Fetal Diagn Ther. 2008;23(2):159–63.CrossRefGoogle ScholarPubMed
Welch, R, Rampling, MW, Anwar, A, Talbert, DG, Rodeck, CH. Changes in hemorheology with fetal intravascular transfusion. Am J Obstet Gynecol. 1994 Mar;170(3):726–32.CrossRefGoogle ScholarPubMed
Lindenburg, IT, Smits-Wintjens, VE, van Klink, JM, et al. Long-term neurodevelopmental outcome after intrauterine transfusion for hemolytic disease of the fetus/newborn: the LOTUS study. Am J Obstet Gynecol. 2012 Feb;206(2):141e1-8.CrossRefGoogle ScholarPubMed
Malin, G, Tonks, AM, Morris, RK, Gardosi, J, Kilby, MD. Congenital lower urinary tract obstruction: a population-based epidemiological study. BJOG. 2012 Nov;119(12):1455–64.CrossRefGoogle ScholarPubMed
Hobbins, JC, Romero, R, Grannum, P, et al. Antenatal diagnosis of renal anomalies with ultrasound. I. Obstructive uropathy. Am J Obstet Gynecol. 1984 Apr 1;148(7):868–77.CrossRefGoogle ScholarPubMed
Morris, RK, Quinlan-Jones, E, Kilby, MD, Khan, KS. Systematic review of accuracy of fetal urine analysis to predict poor postnatal renal function in cases of congenital urinary tract obstruction. Prenat Diagn. 2007 Oct;27(10):900–11.Google Scholar
Ruano, R, Sananes, N, Wilson, C, et al. Fetal lower urinary tract obstruction: proposal for standardized multidisciplinary prenatal management based on disease severity. Ultrasound Obstet Gynecol. 2016 Oct;48(4):476–82.CrossRefGoogle ScholarPubMed
Kurtz, MP, Koh, CJ, Jamail, GA, et al. Factors associated with fetal shunt dislodgement in lower urinary tract obstruction. Prenat Diagn. 2016 Aug;36(8):720–5.CrossRefGoogle ScholarPubMed
Sananes, N, Cruz-Martinez, R, Favre, R, et al. Two-year outcomes after diagnostic and therapeutic fetal cystoscopy for lower urinary tract obstruction. Prenat Diagn. 2016 Apr;36(4):297–303.Google Scholar
Morris, RK, Malin, GL, Quinlan-Jones, E, et al. Percutaneous vesicoamniotic shunting versus conservative management for fetal lower urinary tract obstruction (PLUTO): a randomised trial. Lancet. 2013 Nov 2;382(9903):1496–506.Google Scholar
Yinon, Y, Kelly, E, Ryan, G. Fetal pleural effusions. Best Pract Res Clin Obstet Gynaecol. 2008 Feb;22(1):77–96.CrossRefGoogle ScholarPubMed
McGivern, MR, Best, KE, Rankin, J, et al. Epidemiology of congenital diaphragmatic hernia in Europe: a register-based study. Arch Dis Child Fetal Neonatal Ed. 2015 Mar;100(2):F137-44.CrossRefGoogle ScholarPubMed
Catania, VD, Muru, A, Pellegrino, M, et al. Isolated fetal ascites, neonatal outcome in 51 cases observed in a tertiary referral center. Eur J Pediatr Surg. 2017 Feb;27(1):102–8.Google ScholarPubMed
Manning, FA, Harrison, MR, Rodeck, C. Catheter shunts for fetal hydronephrosis and hydrocephalus. Report of the International Fetal Surgery Registry. N Engl J Med. 1986 Jul 31;315(5):336–40.Google Scholar
Taghavi, K, Beasley, S. The ex utero intrapartum treatment (EXIT) procedure: application of a new therapeutic paradigm. J Paediatr Child Health. 2013 Sep;49(9):E420-7.CrossRefGoogle ScholarPubMed
Tonni, G, Granese, R, Martins Santana, EF, et al. Prenatally diagnosed fetal tumors of the head and neck: a systematic review with antenatal and postnatal outcomes over the past 20 years. J Perinat Med. 2017 Feb 1;45(2):149–65.CrossRefGoogle ScholarPubMed
Joyeux, L, Danzer, E, Flake, AW, Deprest, J. Fetal surgery for spina bifida aperta. Arch Dis Child Fetal Neonatal Ed. 2018 Nov;103(6):F589–F595.CrossRefGoogle ScholarPubMed
Ferschl, M, Ball, R, Lee, H, Rollins, MD. Anesthesia for in utero repair of myelomeningocele. Anesthesiology. 2013 May;118(5):1211–23.CrossRefGoogle ScholarPubMed
Adzick, NS, Thom, EA, Spong, CY, et al. A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med. 2011 Mar 17;364(11):993–1004.CrossRefGoogle ScholarPubMed
Graf, K, Kohl, T, Neubauer, BA, et al. Percutaneous minimally invasive fetoscopic surgery for spina bifida aperta. Part III: neurosurgical intervention in the first postnatal year.Ultrasound Obstet Gynecol. 2016 Feb;47(2):158–61.CrossRefGoogle ScholarPubMed
Gellis, L, Tworetzky, W. The boundaries of fetal cardiac intervention: Expand or tighten? Semin Fetal Neonatal Med. 2017 Dec;22(6):399–403.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×