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Fetal diagnosis and fetal surgery
1Department of Surgery, Wellington School of Medicine (University of Otago), New Zealand.
Clinics in Perinatology
|March 1, 1989
Summary
Advances in fetal diagnosis and surgery offer new hope for unborn babies. However, in-utero diagnosis may worsen prognosis, and fetal surgery, while promising, requires careful ethical consideration.
Area of Science:
- Perinatal Medicine
- Fetal Surgery
- Diagnostic Imaging
Background:
- Fetal diagnosis has advanced significantly with techniques like amniocentesis, ultrasound, and fetal blood sampling.
- Early diagnosis of fetal anomalies is crucial, but in-utero detection can sometimes indicate a poorer prognosis compared to neonatal diagnosis.
Purpose of the Study:
- To review the evolution and current state of fetal diagnosis and surgery.
- To discuss the efficacy and outcomes of various fetal interventions.
- To highlight the potential and challenges of in-utero surgical procedures.
Main Methods:
- Review of diagnostic techniques including amniocentesis, ultrasound, and chorion villous sampling.
- Analysis of outcomes for fetal interventions such as transfusions, shunting for hydrocephalus and obstructive uropathy, and surgical correction of conditions like diaphragmatic hernia.
Main Results:
- Closed techniques for fetal transfusion are safer and effective.
- Shunting for obstructive uropathy shows a 50% survival rate with good outcomes for survivors.
- Shunting for hydrocephalus has disappointing results, with many survivors experiencing severe handicaps.
- Open fetal surgery for conditions like diaphragmatic hernia shows potential.
Conclusions:
- Fetal diagnosis and surgical interventions have advanced considerably.
- While some fetal surgeries show promise, outcomes vary significantly by condition.
- Further research and clear ethical guidelines are necessary before fetal surgery becomes routine.