title: Fetal surgical intervention: progress and perspectives.
abstract: Building upon over 30 years of experimental and clinical development, fetal surgery can be argued to be a standard of care for selected indications, though application of these techniques remains limited to a small number of highly selected fetuses, and availability to a small number of highly specialized centers. Despite its limited application to date, the field of fetal surgery continues to evolve, spurred both by technological advances allowing earlier and more accurate diagnosis of fetal anomalies as well as improved capability to intervene when appropriate. The efficacy of fetal surgical intervention has now been validated for selected indications by well-designed, randomized controlled trials. In this review, we summarize the evidence or lack thereof supporting the current most common indications for fetal surgical intervention.
authors.affiliation: Center for Fetal Diagnosis and Therapy, Department of Surgery, Children's Hospital of Philadelphia, Abramson Research Bldg, Rm 1116B, 3615 Civic Center Blvd, Philadelphia, PA 19104-4318, USA.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Vrecenak
authors.forename: Alan W
authors.initials: AW
authors.lastname: Flake
mesh_terms: D000818:Animals; D005260:Female; D005315:Fetal Diseases / Q000601:surgery*; D005330:Fetofetal Transfusion / Q000601:surgery; D005333:Fetus / Q000601:surgery*; D006548:Hernia, Diaphragmatic / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D008428:Maternal Mortality; D008591:Meningomyelocele / Q000601:surgery; D011247:Pregnancy; D016135:Spinal Dysraphism / Q000601:surgery
references.citation: J Pediatr Surg. 1997 Mar;32(3):448-52
references.pmid: 9094015
references.citation: Semin Pediatr Surg. 1996 Nov;5(4):266-74
references.pmid: 8936656
references.citation: Ultrasound Obstet Gynecol. 2009 Jan;33(1):64-9
references.pmid: 18844275
references.citation: J Pediatr Surg. 2007 Sep;42(9):1561-5
references.pmid: 17848249
references.citation: Am J Obstet Gynecol. 2006 Mar;194(3):834-9
references.pmid: 16522421
references.citation: Pediatr Res. 2006 Aug;60(2):131-5
references.pmid: 16864691
references.citation: N Engl J Med. 2003 Nov 13;349(20):1916-24
references.pmid: 14614166
references.citation: AJR Am J Roentgenol. 2006 Oct;187(4):W350-6
references.pmid: 16985105
references.citation: J Pediatr Surg. 2007 Jan;42(1):107-10; discussion 110-1
references.pmid: 17208549
references.citation: J Pediatr Surg. 2002 Mar;37(3):331-8
references.pmid: 11877643
references.citation: N Engl J Med. 1982 Mar 11;306(10):591-3
references.pmid: 7057815
references.citation: J Pediatr Surg. 1997 Jul;32(7):986-90
references.pmid: 9247218
references.citation: Nat Med. 1995 Apr;1(4):342-7
references.pmid: 7585064
references.citation: Lancet. 1998 Nov 21;352(9141):1675-6
references.pmid: 9853442
references.citation: Prenat Diagn. 2010 Jul;30(7):653-67
references.pmid: 20572114
references.citation: J Pediatr Surg. 2007 Aug;42(8):1351-6
references.pmid: 17706495
references.citation: J Pediatr Surg. 1978 Jun;13(3):227-30
references.pmid: 671187
references.citation: J Pediatr Surg. 1974 Jun;9(3):389-98
references.pmid: 4843993
references.citation: Fetal Diagn Ther. 2008;24(3):237-40
references.pmid: 18753764
references.citation: Pediatr Pathol Lab Med. 1996 Sep-Oct;16(5):701-12
references.pmid: 9025869
references.citation: Prenat Diagn. 2012 Dec;32(12):1127-32
references.pmid: 22990987
references.citation: J Pediatr Surg. 1996 Jan;31(1):148-51; discussion 151-2
references.pmid: 8632269
references.citation: Fetal Diagn Ther. 2012;31(4):264-8
references.pmid: 22354268
references.citation: J Pediatr Surg. 2011 Jul;46(7):1325-32
references.pmid: 21763829
references.citation: Semin Fetal Neonatal Med. 2010 Dec;15(6):349-56
references.pmid: 20855238
references.citation: West J Med. 1993 Sep;159(3):341-9
references.pmid: 8236976
references.citation: Ultrasound Obstet Gynecol. 2009 Sep;34(3):304-10
references.pmid: 19658113
references.citation: Am J Obstet Gynecol. 2010 Sep;203(3):209.e1-6
references.pmid: 20537307
references.citation: Clin Perinatol. 2009 Jun;36(2):363-76, x
references.pmid: 19559325
references.citation: Surgery. 1980 Aug;88(2):260-8
references.pmid: 6893089
references.citation: J Pediatr Surg. 2012 Jan;47(1):36-9
references.pmid: 22244389
references.citation: Clin Perinatol. 2009 Jun;36(2):329-47, ix
references.pmid: 19559323
references.citation: J Pediatr. 1989 Jun;114(6):1023-8
references.pmid: 2656957
references.citation: Am J Obstet Gynecol. 2000 Nov;183(5):1059-66
references.pmid: 11084541
references.citation: JAMA. 1999 Nov 17;282(19):1826-31
references.pmid: 10573273
references.citation: J Pediatr Surg. 1982 Apr;17(2):115-22
references.pmid: 7077490
references.citation: Ultrasound Obstet Gynecol. 2007 Jul;30(1):67-71
references.pmid: 17587219
references.citation: Am J Obstet Gynecol. 2004 Oct;191(4):1430-6
references.pmid: 15507978
references.citation: Am J Obstet Gynecol. 2007 Oct;197(4):392.e1-8
references.pmid: 17904973
references.citation: Dev Med Child Neurol. 2012 Jan;54(1):15-22
references.pmid: 22126123
references.citation: N Engl J Med. 2004 Jul 8;351(2):136-44
references.pmid: 15238624
references.citation: Semin Fetal Neonatal Med. 2010 Feb;15(1):15-20
references.pmid: 19539549
references.citation: Fetal Diagn Ther. 2001 Jul-Aug;16(4):241-4
references.pmid: 11399888
references.citation: Pediatr Neurosurg. 1998 Nov;29(5):274-8
references.pmid: 9917546
references.citation: JAMA. 1981 Aug 14;246(7):774-7
references.pmid: 7253145
references.citation: Am J Obstet Gynecol. 1998 Oct;179(4):884-9
references.pmid: 9790364
references.citation: Lancet. 1986 Apr 19;1(8486):917-8
references.pmid: 2870386
references.citation: J Appl Physiol (1985). 2003 Mar;94(3):1054-62
references.pmid: 12571135
references.citation: Ultrasound Obstet Gynecol. 2000 Dec;16(7):620-4
references.pmid: 11169367
references.citation: Semin Fetal Neonatal Med. 2010 Feb;15(1):9-14
references.pmid: 19540177
references.citation: Prenat Diagn. 2003 Aug;23(8):634-9
references.pmid: 12913869
references.citation: Semin Pediatr Surg. 1993 May;2(2):113-20
references.pmid: 8062028
references.citation: J Pediatr Surg. 2004 Mar;39(3):430-8; discussion 430-8
references.pmid: 15017565
references.citation: J Perinatol. 1999 Dec;19(8 Pt 1):550-5
references.pmid: 10645517
references.citation: N Engl J Med. 2011 Mar 17;364(11):993-1004
references.pmid: 21306277
references.citation: J Pediatr Surg. 2003 Feb;38(2):248-50
references.pmid: 12596115
references.citation: J Pediatr Surg. 1995 Jul;30(7):1028-32; discussion 1032-3
references.pmid: 7472926
references.citation: J Pediatr Surg. 2009 Jan;44(1):60-5
references.pmid: 19159718
references.citation: Neonatology. 2010;98(4):354-64
references.pmid: 20980772
references.citation: Ultrasound Obstet Gynecol. 2005 Feb;25(2):112-8
references.pmid: 15660446
references.citation: Am J Obstet Gynecol. 2007 Oct;197(4):422.e1-4
references.pmid: 17904987
references.citation: Fetal Diagn Ther. 2007;22(5):365-71
references.pmid: 17556826
references.citation: Ultrasound Obstet Gynecol. 2007 Nov;30(6):897-906
references.pmid: 17963204