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Maternal risks of fetal therapy

Al-Refai, Alyaa; Ryan, Greg; Van Mieghem, Tim

Current Opinion in Obstetrics and Gynecology: April 2017 - Volume 29 - Issue 2 - p 80–84
doi: 10.1097/GCO.0000000000000346
PRENATAL DIAGNOSIS: Edited by Jane Chueh

Purpose of review Although most fetal disorders can be treated after birth, a few conditions that predictably lead to fetal or neonatal death, or that progress significantly before birth, are ideally treated prenatally. The number of centers offering fetal therapeutic procedures is gradually increasing worldwide. Patients and caregivers should be aware of the potential maternal risks of these interventions.

Recent findings For transplacental medical therapy (corticosteroids, antiarrhythmics and immunoglobulins), severe maternal adverse events are rare, when done in expert centers. Minimally invasive procedures carry a risk of maternal complications of about 5%, with 1% being severe complications (pulmonary edema or placental abruption). Open fetal surgery carries important risks to the mother, both in the index pregnancy (pulmonary edema, placental abruption, chorioamnionitis and scar dehiscence) and in subsequent pregnancies (uterine rupture), yet some of these risks are decreasing with surgical refinement and increasing experience of the surgical team.

Summary The information in this manuscript provides a base to counsel expectant mothers on risk of fetal therapy.

Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada

Correspondence to Tim Van Mieghem, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, 3-912, Toronto, ON, Canada M5G 1Z6. Tel: +1 416 586 4900x6406; fax: +1 416 586 8617; e-mail: Tim.VanMieghem@SinaiHealthSystem.ca

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