[Indirect transplacental therapy of the fetus]

The paper is a review on the actual possibilities and indications of the transplacentar therapy of the fetus. At first some principles of the pharmacodynamics of the materno-placento-fetal unit are explained in order to enable an effective drug administration and reach therapeutic levels in the fetus. Common and less common diseases of the fetus and their therapy are exposed, such as the acceleration of lung maturation with corticosteroids, the cardioversion of tachycardias with digoxin and other antiarrhythmic drugs, the therapy of toxoplasmosis with pyrimethamine, the treatment of polyhydramnios using indomethacin, the therapy of very rare inborn errors of metabolism, the therapy of thrombocytopenia and the prevention of neural tube defects by folic acid supplementation. For these diseases the pathophysiologic background, the therapy rationale and possible side effects of therapy were exposed. Prior to an intrauterine therapy the perinatologist has to ask himself the 5 "W"-

Which fetus to treat? Why to treat? When to treat? Who will treat? Way of treatment?