Invasive fetal therapy

Although most prenatally diagnosed anatomic malformations are best managed after birth, we can presently offer prenatal therapy to an increasing numbe r of fetuses with simple anatomical defects that have predictably devastati ng developmental consequences. A condition amenable to prenatal interventio n must fulfill a number of conditions. It must be severe enough to warrant the risks associated with in utero treatment and must be reliably detectabl e before birth. Furthermore, the pathophysiology must be reversible by feta l intervention, significantly improving the prognosis over postnatal treatm ent. Current indication for prenatal intervention include decompression for obstructive uropathy, temporary tracheal occlusion for congenital diaphrag matic hernia, and tumor debulking for congenital cystic adenomatoid malform ation of the lung and sacrococcygeal teratoma. Prenatal repair of myelomeni ngocele is currently being developed but remains controversial since this i s not a lethal malformation. Maternal safety remains paramount in consideri ng fetal intervention. The main associated risks are preterm labor and pret erm premature rupture of membranes. To reduce maternal morbidity and the ri sk of prematurity, minimally invasive fetoscopic techniques were developed and are increasingly employed. These developments will in all probability r educe the importance of open fetal surgery in the future.