Multimodal approach in invasive fetal therapy

Background. Integrated fetal therapy is a new approach to prenatal manageme nt consisting of a combination of invasive procedures which complement each other to provide as much information as possible on the fetal compartments . Methods. We carried out a study on 50 fetuses of singleton pregnancies unde rgoing invasive procedures - at least three per fetus - for diagnostic and therapeutical purposes. A total of two hundred and fifty invasive procedure s were adopted. The study population was divided into two groups, those stu died between 1988 and 1992 and those studied between 1993 and 1995. Results. The diagnostic and therapeutic utility of complementary invasive p rocedures in fetuses with nonimmune fetal hydrops and urinary tract malform ations was assessed. In fetuses with nonimmune fetal hydrops integrated inv asive procedures markedly affected the fetal-neonatal survival rate, wherea s in those with urinary tract malformations scheduled for postnatal surgery these procedures made it possible to limit intrauterine renal damage. Conclusions. Complementary invasive procedures in NIFH fetuses particularly influence the fetal-neonatal survival rate. Since urinary tract malformati ons must be treated by postnatal surgery, complementary invasive procedures serve to limit intrauterine renal damage in the meantime and to reduce ces arean section rate.