title: Fetal therapy: state of the art.
abstract: OBJECTIVE
  To review our experience with the use of sonography in evaluating potential candidates for in utero fetal therapy performed at The Center for Fetal Diagnosis and Treatment at The Children's Hospital of Philadelphia.
  
  
  METHODS
  This review article was designed to discuss open hysterotomy for the 4 fetal surgical procedures that have been performed at our institution. The procedures included surgical repair of myelomeningocele, resection of sacrococcygeal teratoma in fetuses with nonimmune hydrops, resection of an enlarging congenital cystic adenomatoid malformation that is not amenable to thoracoamniotic shunting, and tracheal clip occlusion for severe left congenital diaphragmatic hernia.
  
  
  RESULTS
  For each surgical procedure, the use of sonography in the prenatal diagnosis of the congenital anomaly was detailed, as were indications for surgery and surgical procedures, postoperative monitoring and finally delivery, postnatal treatment, and long-term follow-up. Three of the procedures have been reasonably successful with rather dramatic results in some cases such that these techniques are still being performed. The 1 exception was open hysterotomy for the tracheal clip procedure for congenital diaphragmatic hernia, which has been abandoned.
  
  
  CONCLUSIONS
  Fetal therapy is a rapidly evolving specialty, which is being practiced at several centers in this country. Sonography is an integral part of this specialty practice and has been used extensively in the diagnosis of some congenital anomalies that have debilitating or lethal consequences for the fetus. Technologic improvements in both sonography and magnetic resonance imaging have assisted tremendously in the many advances herein reported in the diagnosis and treatment of the above-described 4 congenital anomalies.
authors.affiliation: Department of Radiology, The University of Pennsylvania Medical Center, Philadelphia 19104, USA.
authors.forename: Beverly G
authors.initials: BG
authors.lastname: Coleman
authors.forename: N Scott
authors.initials: NS
authors.lastname: Adzick
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Crombleholme
authors.forename: Mark P
authors.initials: MP
authors.lastname: Johnson
authors.forename: Lori
authors.initials: L
authors.lastname: Howell
authors.forename: Steven C
authors.initials: SC
authors.lastname: Horii
authors.forename: Jill E
authors.initials: JE
authors.lastname: Langer
authors.forename: Harvey L
authors.initials: HL
authors.lastname: Nisenbaum
authors.forename: Suzanne
authors.initials: S
authors.lastname: DeBari
authors.forename: Christopher
authors.initials: C
authors.lastname: Iyoob
mesh_terms: D015615:Cystic Adenomatoid Malformation of Lung, Congenital / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008591:Meningomyelocele / Q000000981:diagnostic imaging / Q000601:surgery; D011247:Pregnancy; D012445:Sacrococcygeal Region / Q000000981:diagnostic imaging; D016135:Spinal Dysraphism / Q000000981:diagnostic imaging; D013724:Teratoma / Q000000981:diagnostic imaging / Q000601:surgery; D016216:Ultrasonography, Prenatal