Indications and outcomes of intrauterine surgery for fetal malformations

Although the efficacy of intrauterine intervention has been clearly demonstrated for some conditions, such as twin to twin transfusion syndrome and twin reversal arterial perfusion, it is still to be determined as treatment of congenital diaphragmatic hernia, cardiac defects, lower urinary tract obstruction and sacrococcygeal teratoma. The aim of the present study was to review literature concerning the benefits and outcomes of fetal intervention for these anomalies together with its limitations and controversies.

Only one randomized clinical trial, which compared prenatal versus postnatal treatment for congenital diaphragmatic hernia, was performed. For the other anomalies, small series were described and showed that fetal surgery drastically changes the natural history of the discussed anomalies, thus it prevents the progression of a disorder that is likely to be fatal. However, controversies exist with regard to operating timing and selection criteria of fetuses that may benefit from fetal surgery.

Further investigations are needed with regard to the definition of appropriate operating timing and standardization of selection criteria. Multicenter randomized trials are also necessary in order to define whether fetal surgery is associated with better outcomes as compared with postnatal treatment.