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Chapter 1 - The Rationale for Fetal Therapy

from Section 1: - General Principles

Published online by Cambridge University Press:  21 October 2019

Mark D. Kilby
Affiliation:
University of Birmingham
Anthony Johnson
Affiliation:
University of Texas Medical School at Houston
Dick Oepkes
Affiliation:
Leids Universitair Medisch Centrum
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Summary

In 1982, a group of subspecialists in fetal medicine, pediatric surgery, pediatrics, radiology, genetics, and bioethics reported on a meeting that discussed the emerging field of ‘fetal therapy’ [1]. Their summary statement laid down the foundation and principles for the treatment of prenatally diagnosed congenital anomalies where the natural history of the disease can potentially be influenced by intervention before birth (Table 1.1). In principle, this document defines the criteria of candidate conditions for fetal therapy, the goals of fetal treatment, and the appropriate setting for where fetal therapy should be performed. Since this original publication there have been significant advances in prenatal diagnostic and prognostic assessments of the fetus, the scope of treatments, and the care settings where fetal therapy is offered that require consideration [2].

Type
Chapter
Information
Fetal Therapy
Scientific Basis and Critical Appraisal of Clinical Benefits
, pp. 1 - 7
Publisher: Cambridge University Press
Print publication year: 2020

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References

Harrison, MR, Filly, RA, Golbus, MS, Berkowitz, RL, Callen, PW, Canty, TG, et al. Fetal treatment 1982. N Engl J Med. 1982; 307: 1651–2.Google Scholar
Moon-Grady, A, Baschat, A, Cass, D, et al. Fetal treatment 2017: the evolution of fetal therapy centers – a joint opinion from the International Fetal Medicine and Surgical Society (IFMSS) and the North American Fetal Therapy Network (NAFTNet). Fetal Diagn Ther. 2017; 42: 241–8.Google Scholar
Snyder, E, Baschat, A, Huisman, TAGM, Tekes, A. Value of fetal MRI in the era of fetal therapy for management of abnormalities involving the chest, abdomen, or pelvis. Am J Roentgenol. 2018; 210: 9981009.Google Scholar
Wapner, RJ, Martin, CL, Levy, B, Ballif, BC, Eng, CM, Zachary, JM, et al. Chromosomal microarray versus karyotyping for prenatal diagnosis. N Engl J Med. 2012; 367: 2175–84.CrossRefGoogle ScholarPubMed
Drury, S, Williams, H, Trump, N, Boustred, C, GOSGene, Lench, N, Scott, RH, Chitty, LS. Exome sequencing for prenatal diagnosis of fetuses with sonographic abnormalities. Prenat Diagn. 2015; 35: 1010–7.Google Scholar
Reddy, UM, Baschat, AA, Zlatnik, MG, Towbin, JA, Harman, CR, Weiner, CP. Detection of viral deoxyribonucleic acid in amniotic fluid: association with fetal malformation and pregnancy abnormalities. Fetal Diagn Ther. 2005; 20: 203–7.Google Scholar
Adams, LL, Gungor, S, Turan, S, Kopelman, JN, Harman, CR, Baschat, AA. When are amniotic fluid viral PCR studies indicated in prenatal diagnosis? Prenat Diagn. 2012; 32: 8893.Google Scholar
Emery, SP, Greene, S, Hogge, WA. Fetal Therapy for Isolated Aqueductal Stenosis. Fetal Diagn Ther. 2015; 38: 81–5.Google Scholar
Micu, R, Chicea, AL, Bratu, DG, Nita, P, Nemeti, G, Chicea, R. Ultrasound and magnetic resonance imaging in the prenatal diagnosis of open spina bifida. Med Ultrason. 2018; 20: 221–7.Google Scholar
Madenci, AL, Sjogren, AR, Treadwell, MC, Ladino-Torres, MF, Drongowski, RA, Kreutzman, J, Bruch, SW, Mychaliska, GB. Another dimension to survival: predicting outcomes with fetal MRI versus prenatal ultrasound in patients with congenital diaphragmatic hernia. J Pediatr Surg. 2013; 48: 1190–7.Google Scholar
Metkus, AP, Filly, RA, Stringer, MD, Harrison, MR, Adzick, NS. Sonographic predictors of survival in fetal diaphragmatic hernia. J Pediatr Surg. 1996; 31: 148–51.Google Scholar
Jani, J, Nicolaides, KH, Keller, RL, Benachi, A, Peralta, CF, Favre, R, et al. Observed to expected lung area to head circumference ratio in the prediction of survival in fetuses with isolated diaphragmatic hernia. Ultrasound Obstet Gynecol. 2007; 30: 6771.CrossRefGoogle ScholarPubMed
Crombleholme, TM, Coleman, B, Hedrick, H, Liechty, K, Howell, L, Flake, AW, Johnson, M, Adzick, NS. Cystic adenomatoid malformation ratio predicts outcome in prenatally diagnosed cystic adenomatoid malformation of the lung. J Pediatr Surg. 2002; 37: 331–8.Google Scholar
Wieczorek, A, Hernandez-Robles, J, Ewing, L, Leshko, J, Luther, S, Huhta, J. Prediction of outcome of fetal congenital heart disease using a cardiovascular profile score. Ultrasound Obstet Gynecol. 2008; 31: 284–8.Google Scholar
Huhta, JC, Paul, JJ. Doppler in fetal heart failure. Clin Obstet Gynecol. 2010; 53: 915–29.Google Scholar
Kim, SA, Lee, SM, Hong, JS, Lee, J, Park, CW, Kim, BJ, et al. Ultrasonographic severity scoring of non-immune hydrops: a predictor of perinatal mortality. J Perinat Med. 2015; 43: 53–9.Google Scholar
Quintero, RA, Morales, WJ, Allen, MH, Bornick, PW, Johnson, PK, Kruger, M. Staging of twin-twin transfusion syndrome. J Perinatol. 1999; 19: 550–5.Google Scholar
Rychik, J, Tian, Z, Bebbington, M, Xu, F, McCann, M, Mann, S, Wilson, RD, Johnson, MP. 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: 392. e1–8.Google Scholar
Shah, AD, Border, WL, Crombleholme, TM, Michelfelder, EC. Initial fetal cardiovascular profile score predicts recipient twin outcome in twin-twin transfusion syndrome. J Am Soc Echocardiogr. 2008; 21: 1105–8.CrossRefGoogle ScholarPubMed
O’Donoghue, K, Cartwright, E, Galea, P, Fisk, NM. Stage I twin-twin transfusion syndrome: rates of progression and regression in relation to outcome. Ultrasound Obstet Gynecol. 2007; 30: 958–64.Google Scholar
Oepkes, D, Seaward, PG, Vandenbussche, FP, Windrim, R, Kingdom, J, Beyene, J, Kanhai, HH, Ohlsson, A, Ryan, G, DIAMOND Study Group. Doppler ultrasonography versus amniocentesis to predict fetal anemia. N Engl J Med. 2006; 355: 156–64.CrossRefGoogle ScholarPubMed
Zwiers, C, Lindenburg, ITM, Klumper, FJ, de Haas, M, Oepkes, D, Van Kamp, IL. Complications of intrauterine intravascular blood transfusion: lessons learned after 1678 procedures. Ultrasound Obstet Gynecol. 2017; 50: 180–6.Google Scholar
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; 315: 336–40.CrossRefGoogle ScholarPubMed
Moon-Grady, AJ, Morris, SA, Belfort, M, Chmait, R, Dangel, J, Devlieger, R, et al. International Fetal Cardiac Intervention Registry: a worldwide collaborative description and preliminary outcomes. J Am Coll Cardiol. 2015; 66: 388–99.Google ScholarPubMed
Bebbington, MW, Danzer, E, Moldenhauer, J, Khalek, N, Johnson, MP. Radiofrequency ablation vs bipolar umbilical cord coagulation in the management of complicated monochorionic pregnancies. Ultrasound Obstet Gynecol. 2012; 40: 319–24.CrossRefGoogle ScholarPubMed
Stephenson, CD, Temming, LA, Pollack, R, Iannitti, DA. Microwave ablation for twin-reversed arterial perfusion sequence: a novel application of technology. Fetal Diagn Ther. 2015; 38: 3540.Google Scholar
Senat, MV, Deprest, J, Boulvain, M, Paupe, A, Winer, N, Ville, Y. Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med. 2004; 351: 136–44.Google Scholar
Quintero, RA, Reich, H, Puder, KS, Bardicef, M, Evans, MI, Cotton, DB, Romero, R: Brief re- port: umbilical-cord ligation of an acardiac twin by fetoscopy at 19 weeks of gestation. N Engl J Med 1994; 330: 469471.Google Scholar
Jani, JC, Nicolaides, KH, Gratacós, E, Valencia, CM, Doné, E, Martinez, JM, Gucciardo, L, Cruz, R, Deprest, JA. Severe diaphragmatic hernia treated by fetal endoscopic tracheal occlusion. Ultrasound Obstet Gynecol. 2009; 34: 304–10.Google Scholar
Richter, J, Wergeland, H, DeKoninck, P, De Catte, L, Deprest, JA. Fetoscopic release of an amniotic band with risk of amputation: case report and review of the literature. Fetal Diagn Ther. 2012; 31: 134–7.CrossRefGoogle ScholarPubMed
Sananes, N, Cruz-Martinez, R, Favre, R, Ordorica-Flores, R, Moog, R, Zaloszy, A, Giron, AM, Ruano, R. Two-year outcomes after diagnostic and therapeutic fetal cystoscopy for lower urinary tract obstruction. Prenat Diagn. 2016; 36: 297303.Google Scholar
Kohl, T, Hering, R, Heep, A, Schaller, C, Meyer, B, Greive, C, et al. Percutaneous fetoscopic patch coverage of spina bifida aperta in the human – early clinical experience and potential. Fetal Diagn Ther. 2006; 21: 185–93.CrossRefGoogle ScholarPubMed
Abraham, RJ, Sau, A, Maxwell, D. A review of the EXIT (Ex utero Intrapartum Treatment) procedure. J Obstet Gynaecol. 2010; 30: 15.Google Scholar
Adzick, NS, Thom, EA, Spong, CY, Brock, JW 3rd, Burrows, PK, Johnson, MP, et al. A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med. 2011; 364: 9931004.Google Scholar
Cass, DL, Olutoye, OO, Ayres, NA, Moise, KJ Jr., Altman, CA, Johnson, A, Cassady, CI, Lazar, DA, Lee, TC, Lantin, MR. Defining hydrops and indications for open fetal surgery for fetuses with lung masses and vascular tumors. J Pediatr Surg. 2012; 47: 40–5.Google Scholar
Liechty, KW, Crombleholme, TM, Flake, AW, Morgan, MA, Kurth, CD, Hubbard, AM, Adzick, NS. Intrapartum airway management for giant fetal neck masses: the EXIT (ex utero intrapartum treatment) procedure. Am J Obstet Gynecol. 1997; 177: 870–4.Google Scholar
Mychaliska, GB, Bealer, JF, Graf, JL, Rosen, MA, Adzick, NS, Harrison, MR. Operating on placental support: the ex utero intrapartum treatment procedure. J Pediatr Surg. 1997; 32: 227–30.Google Scholar
Norris, MC, Joseph, J, Leighton, BL. Anaesthesia for perinatal surgery. Am J Perinatol. 1989; 6: 3940.Google Scholar
Slaghekke, F, Lopriore, E, Lewi, L, Middeldorp, JM, van Zwet, EW, Weingertner, AS, et al. Fetoscopic laser coagulation of the vascular equator versus selective coagulation for twin-to-twin transfusion syndrome: an open-label randomised controlled trial. Lancet. 2014; 383: 2144–51.Google Scholar
Peeters, SH, Van Zwet, EW, Oepkes, D, Lopriore, E, Klumper, FJ, Middeldorp, JM. Learning curve for fetoscopic laser surgery using cumulative sum analysis. Acta Obstet Gynecol Scand. 2014; 93: 705–11.Google Scholar
Inglis, SR, Lysikiewicz, A, Sonnenblick, AL, Streltzoff, JL, Bussel, JB, Chervenak, FA. Advantages of larger volume, less frequent intrauterine red blood cell transfusions for maternal red cell alloimmunization. Am J Perinatol. 1996; 13: 2733.CrossRefGoogle ScholarPubMed
Edwards, AG, Teoh, M, Hodges, RJ, Palma-Dias, R, Cole, SA, Fung, AM, Walker, SP. Balancing Patient Access to fetoscopic laser photocoagulation for twin-to-twin transfusion syndrome with maintaining procedural competence: are collaborative services part of the solution? Twin Res Hum Genet. 2016; 19: 276–84.Google Scholar
Perry, KG Jr., Hess, LW, Roberts, WE, Allbert, JR, Floyd, RC, McCaul, JF, Martin, RW, Martin, JN Jr., Morrison, JC. Cordocentesis (funipuncture) by maternal-fetal fellows: the learning curve. Fetal Diagn Ther. 1991; 6: 8792.Google Scholar
Chang, YL, Chao, AS, Chang, SD, Hsieh, PC, Wang, CN. Short-term outcomes of fetoscopic laser surgery for severe twin-twin transfusion syndrome from Taiwan single center experience: demonstration of learning curve effect on the fetal outcomes. Taiwan J Obstet Gynecol. 2012; 51: 350–3.Google Scholar
Cohen, AR, Couto, J, Cummings, JJ, Johnson, A, Joseph, G, Kaufman, BA, et al. Position statement on fetal myelomeningocele repair. Am J Obstet Gynecol. 2014; 210: 107–11.Google Scholar
Belfort, MA, Whitehead, WE, Shamshirsaz, AA, Ruano, R, Cass, DL, Olutoye, OO. Fetoscopic repair of meningomyelocele. Obstet Gynecol. 2015; 126: 881–4.Google Scholar
Araujo Júnior, E, Tonni, G, Martins, WP, Ruano, R. Procedure-related complications and survival following Fetoscopic Endotracheal Occlusion (FETO) for severe congenital diaphragmatic hernia: systematic review and meta-analysis in the FETO Era. Eur J Pediatr Surg. 2016; 27: 297305.Google ScholarPubMed
Grushka, JR, Laberge, JM, Puligandla, P, Skarsgard, ED, Canadian Pediatric Surgery Network: effect of hospital case volume on outcome in congenital diaphragmatic hernia: the experience of the Canadian Pediatric Surgery Network. J Pediatr Surg. 2009; 44: 873–6.Google Scholar
Snoek, KG, Greenough, A, van Rosmalen, J, Capolupo, I, Schaible, T, Ali, K, Wijnen, RM, Tibboel, D. Congenital diaphragmatic hernia: 10-Year evaluation of survival, extracorporeal membrane oxygenation, and foetoscopic endotracheal occlusion in four high-volume centres. Neonatology. 2018; 113: 63–8.Google Scholar
Sanapo, L, Moon-Grady, AJ, Donofrio, MT. Perinatal and delivery management of infants with congenital heart disease. Clin Perinatol. 2016; 43: 5571.CrossRefGoogle ScholarPubMed
Loh, KC, Jelin, E, Hirose, S, Feldstein, V, Goldstein, R, Lee, H. Microcystic congenital pulmonary airway malformation with hydrops fetalis: steroids vs open fetal resection. J Pediatr Surg. 2012; 47: 36–9.CrossRefGoogle ScholarPubMed
Baschat, AA, Ahn, ES, Murphy, J, Miller, JL. Fetal blood gas values during fetoscopic myelomeningocele repair performed under carbon dioxide insufflation. Ultrasound Obstet Gynecol. 2018; 52: 400402.Google Scholar
Wulff, CB, Gerds, TA, Rode, L, Ekelund, CK, Petersen, OB, Tabor, A, Danish Fetal Medicine Study Group: risk of fetal loss associated with invasive testing following combined first-trimester screening for Down syndrome: a national cohort of 147,987 singleton pregnancies. Ultrasound Obstet Gynecol. 2016; 47: 3844.Google Scholar
Enzensberger, C, Pulvermacher, C, Degenhardt, J, Kawacki, A, Germer, U, Gembruch, U, Krapp, M, Weichert, J, Axt-Fliedner, R. Fetal loss rate and associated risk factors after amniocentesis, chorionic villus sampling and fetal blood sampling. Ultraschall Med. 2012; 33: E75–9.Google ScholarPubMed
Society for Maternal-Fetal Medicine, Berry, SM, Stone, J, Norton, ME, Johnson, D, Berghella, V. Fetal blood sampling. Am J Obstet Gynecol. 2013; 209: 170–80.CrossRefGoogle ScholarPubMed
Bigelow, CA, Cinelli, CM, Little, SE, Benson, CB, Frates, MC, Wilkins-Haug, LE. Percutaneous umbilical blood sampling: current trends and outcomes. Eur J Obstet Gynecol Reprod Biol. 2016; 200: 98101.Google Scholar
Wilson, RD, Gagnon, A, Audibert, F, Campagnolo, C, Carroll, J, Genetics committee: prenatal diagnosis procedures and techniques to obtain a diagnostic fetal specimen or tissue: maternal and fetal risks and benefits. J Obstet Gynaecol Can. 2015; 37: 656–68.CrossRefGoogle ScholarPubMed
Papanna, R, Block-Abraham, D, Mann, LK, Buhimschi, IA, Bebbington, M, Garcia, E, Kahlek, N, Harman, C, Johnson, A, Baschat, A, Moise, KJ Jr. Risk factors associated with preterm delivery after fetoscopic laser surgery for twin-twin transfusion syndrome. Ultrasound Obstet Gynecol. 2014; 43: 4853.Google Scholar
Ruano, R, Sananes, N, Sangi-Haghpeykar, H, Hernandez-Ruano, S, Moog, R, Becmeur, F, Zaloszyc, A, Giron, A, Morin, B, Favre, R. Fetal intervention for severe lower urinary tract obstruction: a multicenter case-control study comparing fetal cystoscopy with vesicoamniotic shunting. Ultrasound Obstet Gynecol. 2015; 45: 452–8.Google Scholar
Moon-Grady, AJ, Morris, SA, Belfort, M, Chmait, R, Dangel, J, Devlieger, R, et al. International fetal cardiac intervention registry: a worldwide collaborative description and preliminary outcomes. J Am Coll Cardiol. 2015; 66: 388–99.Google Scholar
Araujo Júnior, E, Tonni, G, Chung, M, Ruano, R, Martins, WP. Perinatal outcomes and intrauterine complications following fetal intervention for congenital heart disease: systematic review and meta-analysis of observational studies. Ultrasound Obstet Gynecol. 2016; 48: 426–33.Google Scholar
Belfort, MA, Whitehead, WE, Shamshirsaz, AA, Ruano, R, Cass, DL, Olutoye, OO. Fetoscopic repair of meningomyelocele. Obstet Gynecol. 2015; 126: 881–4.Google Scholar
Johnson, MP, Bennett, KA, Rand, L, Burrows, PK, Thom, EA, Howell, LJ, et al. The Management of Myelomeningocele Study: obstetrical outcomes and risk factors for obstetrical complications following prenatal surgery. Am J Obstet Gynecol. 2016; 215: 778. e1–778. e9.Google Scholar
Crenshaw, C Jr., Payne, P, Blackmon, L, Bowen, C, Gutberlet, R. Prematurity and the obstetrician. A regional neonatal intensive care nursery is not enough. Am J Obstet Gynecol. 1983; 147: 125–32.Google Scholar
American Academy of Pediatrics Committee on Fetus and Newborn. Policy statement: Levels of Neonatal Care. Pediatrics. 2012; 130: 587–97.Google Scholar
Task Force for Children’s Surgical Care. Optimal resources for children’s surgical care in the United States. J Am Coll Surg. 2014; 218: 479–87.Google Scholar
Birkmeyer, JD, Stukel, TA, Siewers, AE, Goodney, PP, Wennberg, DE, Lucas, FL. Surgeon volume and operative mortality in the United States. New Engl J Med. 2003; 349: 2117–27.CrossRefGoogle ScholarPubMed
Grayson, AD, Moore, RK, Jackson, M, Rathore, S, Sastry, S, Gray, TP, Schofield, I, Chauhan, A, Ordoubadi, FF, Prendergast, B, Stables, RH. north west quality improvement programme in cardiac interventions: multivariate prediction of major adverse cardiac events after 9914 percutaneous coronary interventions in the north west of England. Heart. 2006; 92: 658–63.Google Scholar
Wright, JD, Herzog, TJ, Siddiq, Z, Arend, R, Neugut, AI, Burke, WM, Lewin, SN, Ananth, CV, Hershman, DL. Failure to rescue as a source of variation in hospital mortality for ovarian cancer. J Clin Oncol. 2012; 30: 3976–82.CrossRefGoogle ScholarPubMed
Slaghekke, F, Lopriore, E, Lewi, L, Middledorp, JM, van Zwet, EW, Weingertner, AS, et al. Fetoscopic laser coagulation of the vascular equator versus selective coagulation for twin-to-twin transfusion syndrome: an open-label randomised controlled trial. Lancet. 2014; 383: 2144–51.Google Scholar

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