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The evidence base for fetal medicine
Pauline Green1, Zarko Alfirevic
1Wirral Hospital Trust, Arrowe Park Road, Upton, Wirral CH49 5PE, UK. pauline.green@whnt.nhs.uk
Summary
Fetal medicine and surgery research is limited, often relying on case reports. Evidence-based practice is crucial for new fetal interventions to ensure safety and efficacy.
Area of Science:
- Fetal medicine
- Fetal surgery
- Evidence-based practice
Background:
- The practice of fetal medicine and surgery currently lacks a robust evidence base.
- Much of the existing activity is supported by case reports and series, rather than high-quality research.
Purpose of the Study:
- To examine the evidence base for fetal medicine and surgery.
- To emphasize the importance of rigorous research for new and established techniques in fetal interventions.
Main Methods:
- Review of current literature on fetal medicine and surgery practices.
- Analysis of the transition towards evidence-based approaches, including randomized trials.
Main Results:
- Limited high-quality research exists, with many practices based on anecdotal evidence.
- New randomized trials are emerging for specific procedures like fetal endoscopic tracheal occlusion and laser treatment for twin-to-twin transfusion syndrome.
- Established techniques may not be suitable for randomization, but new related techniques require well-designed trials.
Conclusions:
- The field of fetal medicine and surgery is increasingly adopting evidence-based practice.
- Well-designed randomized trials are essential for validating new fetal interventions, ensuring safety, clinical utility, and superiority over standard care.
- Ethical considerations in fetal interventions necessitate solid evidence of short- and long-term benefits before widespread adoption of novel techniques.