[Fetal surgery: for selected patients. The experiences of the Fetal Treatment Center in San Francisco]

Foetal surgery, i.e. invasive treatment of the unborn child, has pros and cons. Foetal surgery is the therapy of choice in a selected group of patients. For obstructive uropathy, intrauterine urinary drainage is seldom indicated due to disappointing results. For congenital diaphragmatic hernia, the pressure in the respiratory tract is increased by tracheal occlusion therapy and so pulmonary hypoplasia is prevented. This probably has a beneficial effect for children with a poor prognosis. For congenital cystic adenomatoid malformation of the lung and foetal hydrops, resection of the lesion gives a survival rate of 70%. For sacrococcygeal teratoma and foetal hydrops, intrauterine resection of the tumour might save the life of the foetus. For high myelomeningocele, intrauterine covering of the defect has until now given no improvement in the neurological outcome. For twin transfusion syndrome, laser coagulation of the placental anastomoses is probably superior to serial amnioreduction. For women the mortality and morbidity associated with foetal surgery are low.