International Dexeus Forum - 44th edition

OBSTETRICS > FETAL PATHOLOGY

“Fetal pathology currently susceptible to intrauterine therapy”

Luc de Catte, University Hospitals UZ Leuven (Belgium)

Few of the common established fetal treatments actually result from adequately performed randomized controlled trials or even animal experiments. Exceptions are laser ablation in TTTS, meningoyelocele repair and plugging for severe congenital diaphragmatic hernia. Results from case series documenting other treatments modalities should be interpreted with caution as patient selection, methods of treatment and outcome parameters may be inconsistent.


Fetal pathology currently susceptible to intrauterine therapy

“A fetal abnormality of any type should never be treated simply 'because it is there' and never by someone unprepared for the awesome responsibility”. This quote from Michael Harrison reflects more than ever today the need for careful patient selection, thorough knowledge of the fetal condition, and highly skilled medical staff as many more fetal therapy centers emerge.

Generally fetal conditions eligible for in utero therapy may results from maternal and/or fetal conditions that impair normal fetal development or result in worse outcome if not treated prenatally and those selective conditions the might evolve towards or present already as fetal hydrops.

Targeted ultrasound examination in pregnancies complicated by either maternal risk factors, such as thyroid dysfunction or autoimmune disease, or abnormal prenatal screening results, such as Rh alloimmunisation of congenital infection, will be mandatory to identify this selective group of conditions. Other fetal conditions may be derived from prenatal ultrasound screening programs and additional work-up, such as congenital diaphragmatic hernia, complications of monochorionic twinning, neural tube defects on lung lesions.

Few of the common established fetal treatments actually result from adequately performed randomized controlled trials or even animal experiments. Exceptions are laser ablation in TTTS, meningoyelocele repair and plugging for severe congenital diaphragmatic hernia. Results from case series documenting other treatments modalities should be interpreted with caution as patient selection, methods of treatment and outcome parameters may be inconsistent.

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