[Problems of and possibilities in fetal surgery].
Recent developments and improvements in prenatal diagnostic methods, and in particular antenatal ultrasonography, have made intrauterine detection of fetal abnormalities possible. Most defects are best treated after birth, only a few disorders are potentially amenable to surgical treatment in utero. Studies in animal models have helped us to define the pathophysiology, to recognize the interference of the abnormality with organ development and to determine whether elimination of the anomaly might allow fetal development to proceed normally. In-utero repair of congenital diaphragmatic hernia has been practiced on a fetal lamb model but has not yet been attempted in human beings. Treatment of fetal hydrocephalus has been investigated in sheep and rhesus monkeys, and the pathophysiology and intrauterine treatment of fetal hydrocephalus has been studied in fetal lambs and monkeys, but the question of the reversibility of renal dysplasia has not been resolved. Animal models have been described for possible intrauterine treatment of skeletal abnormalities like spina bifida. But more knowledge of embryology and of the pathophysiology of the malformation is needed, as well as about the efficacy and feasibility of this method before it can be attempted in human beings. Prerequisites for fetal surgery include the selection of those fetuses who might benefit from intrauterine treatment, counselling of the family concerned, and a highly experienced multidisciplinary team including a perinatal obstetrician, an ultrasonographer, a pediatric surgeon and a neonatologist. In human beings intrauterine treatment has been performed in erythroblastosis fetalis, urinary tract obstruction and hydrocephalus with encouraging results. There are many ethical, legal and social questions which cannot be answered; new guidelines and rules will have to be laid down.(ABSTRACT TRUNCATED AT 250 WORDS)
D000818:Animals; D001805:Blood Transfusion, Intrauterine; D002557:Cerebrospinal Fluid Shunts / Q000379:methods; D000013:Congenital Abnormalities / Q000601:surgery*; D004899:Erythroblastosis, Fetal / Q000628:therapy; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy; D006551:Hernia, Hiatal / Q000601:surgery; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D006869:Hydronephrosis / Q000601:surgery; D007409:Intestinal Atresia / Q000601:surgery; D008253:Macaca mulatta; D011247:Pregnancy; D011535:Prune Belly Syndrome / Q000601:surgery; D012756:Sheep; D014517:Ureteral Obstruction / Q000601:surgery
Problematik und Möglichkeiten der Fetalchirurgie.