title: The unborn surgical patient. A nursing frontier.
abstract: The fetus can now be considered a patient. Sophisticated imaging techniques and prenatal tests have allowed precise diagnosis of fetal abnormalities. Subsequent recommendations for treatment are evolving depending on diagnosis and progression of disease. For severely affected fetuses with life-threatening problems, fetal surgery is a proposed intervention. Knowledge of the diagnosis and potential treatment modalities are now a prerequisite for providing the necessary support and care of mothers of fetuses with an anomaly. The fetal treatment center provides a regionalized approach to providing specialized care to the mother carrying a fetus with an anomaly. The center provides both prenatal and postnatal diagnosis; treatment; and obstetric, neonatal, and pediatric surgical management for a wide variety of pediatric surgical disorders. The fetal treatment center model is a useful one offering knowledgeable, coordinated, efficient, and compassionate care to parents facing difficult decisions regarding their unborn child. Future interventions include less invasive procedures to the mother, such as videofetoscopic techniques. Use of new research related to scarless wound healing may allow endoscopic techniques to correct cleft lips in utero. Gene and stem cell therapy in utero may ameliorate blood disorders, enzyme deficiencies, hemoglobinopathies, and so on prior to birth. Finally, other lethal fetal anomalies, such as pulmonary atresia and laryngeal atresia may also benefit from in utero intervention.
authors.affiliation: Fetal Treatment Center, University of California, San Francisco.
authors.forename: L J
authors.initials: LJ
authors.lastname: Howell
mesh_terms: D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000451:nursing* / Q000601:surgery*; D006801:Humans; D018579:Patient Selection; D013527:Perioperative Nursing; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012495:San Francisco