Fetal medicine: treating the unborn patient

Fetal medicine is a rapidly growing discipline that combines the expertise of many specialties, including obstetrics, neonatology and pediatric surgery. The field is unique in that the physician rarely touches or sees the unborn patient directly. Thus, recent advances in ultrasonographic imaging (real-time and increased-resolution imaging) have played a pivotal role in the development of fetal diagnosis and therapy. Fetal access must take into account the safety of the mother and includes intra-amniotic, intracordal and fetal intramuscular routes. Medical treatment of the fetus includes exchange transfusion, thyroid hormone replacement and administration of steroids for surfactant induction. Correction of obstructive uropathy with urinary diversion has proved successful in decreasing fetal morbidity and mortality, while other procedures are still in the experimental stage. Extrauterine fetal surgery is performed only rarely but represents an exciting new direction in the treatment of medicine's youngest patients.