[The fetal diseases--recent advances in the fetal diagnosis and therapy]

To know the pathophysiological conditions of the fetus as a patient is very important for the determinations of methods of fetal diagnosis and therapy. The mechanisms by which maternal infection triggers the uterine contraction are poorly under stood. Firstly, we investigated the role of maternal endotoxin and heat stress. Studies were carried out in 6 chronically prepared, pregnant goats or sheep at 129 to 137 days gestation. Blood samples were collected for determinations of plasma interleukin-1, PGF2 alpha, cortisol and catecholamines levels from mother and fetus after infusion of 1.0 mg E. Coli endotoxin into the maternal jugular vein. From these animal experiments, it is demonstrated that maternal interleukin-1 PGF2 alpha levels tended to rise, and these endocrinological or interleukin-1 changes induced the uterine contraction during maternal hyperthermia. Recently, diagnostic technique in detections of fetal diseases have undergone a major revolution by the appearance of real-time ultrasound, predictive genetic testing using DNA prove and cordocentesis. Drug therapy and surgical therapy in the fetus have also undergone considerable changes, however, previous attempts at therapy have been generally unsatisfactory and rarely successful. Recently, we performed a new technique for dead fetus removal in utero by selective cesarean in a case of monochorionic monoamniotic twin pregnancy with intrauterine death of one twin at 28 weeks' gestation. The patient was delivered by re-cesarean section at 33 weeks' gestation on five weeks after first surgery was hospitalized for small-for-dates. Ethics in the development of fetal diagnosis and therapy are controversial. We never forget to gain from parents the informed consent.