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Fetal Surgery: An Overview

Sala, Paolo MD*; Prefumo, Federico MD, PhD; Pastorino, Daniela MD; Buffi, Davide MD; Gaggero, Chiara Roberta MD§; Foppiano, Marilena MD§; De Biasio, Pierangela MD

Obstetrical & Gynecological Survey: April 2014 - Volume 69 - Issue 4 - p 218–228
doi: 10.1097/OGX.0000000000000061
CME ARTICLES
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CME

In utero fetal surgery interventions are currently considered in selected cases of congenital diaphragmatic hernia, cystic pulmonary abnormalities, amniotic band sequence, selected congenital heart abnormalities, myelomeningocele, sacrococcygeal teratoma, obstructive uropathy, and complications of twin pregnancy. Randomized controlled trials have demonstrated an advantage for open fetal surgery of myelomeningocele and for fetoscopic selective laser coagulation of placental vessels in twin-to-twin transfusion syndrome. The evidence for other fetal surgery interventions, such as tracheal occlusion in congenital diaphragmatic hernia, excision of lung lesions, fetal balloon cardiac valvuloplasty, and vesicoamniotic shunting for obstructive uropathy, is more limited. Conditions amenable to intrauterine surgical treatment are rare; the mother may consider termination of pregnancy as an option for many of them; treatment can be lifesaving but in itself carries risks to both the infant (preterm premature rupture of the membranes, preterm delivery) and the mother. This makes conducting prospective or randomized trials difficult and explains the relative lack of good-quality evidence in this field. Moreover, there is scanty information on long-term outcomes. It is recommended that fetal surgery procedures be performed in centers with extensive facilities and expertise. The aims of this review were to describe the main fetal surgery procedures and their evidence-based results and to provide generalist obstetricians with an overview of current indications for fetal surgery.

Target Audience Obstetricians and gynecologists, family physicians

Learning Objectives After completing this CME activity, physicians should be better able to describe the main fetal surgery procedures currently performed, to identify the main fetal pathological conditions amenable to intrauterine surgical treatment, and to compare the effectiveness of different fetal surgical procedures available for individual conditions.

*Trainee in Obstetrics and Gynecology, Department of Obstetrics and Gynecology, IRCCS A.O.U. San Martino IST, Genoa, Italy; †Consultant, Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy; ‡Consultant, Division of Obstetrics and Gynecology, Laboratory of Prenatal Diagnosis, IRCCS G. Gaslini Institute, Genoa, Italy; and §Research Fellow, Division of Obstetrics and Gynecology, Laboratory of Prenatal Diagnosis, IRCCS G. Gaslini Institute, Genoa, Italy

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

The authors have disclosed that the US Food and Drug Administration has not approved the use of in utero procedures for the treatment of congenital heart disease as discussed in this article.

Correspondence requests to: Paolo Sala, MD, Department of Obstetrics and Gynecology, IRCCS A.O.U. San Martino IST, Largo R. Benzi 1, 16132 Genoa, Italy. E-mail: paolsala@gmail.com.

© 2014 by Lippincott Williams & Wilkins.