title: Fetal surgery: an overview.
abstract: In utero fetal surgery interventions are currently considered in selected cases of congenital diaphragmatic hernia, cystic pulmonary abnormalities, amniotic band sequence, selected congenital heart abnormalities, myelomeningocele, sacrococcygeal teratoma, obstructive uropathy, and complications of twin pregnancy. Randomized controlled trials have demonstrated an advantage for open fetal surgery of myelomeningocele and for fetoscopic selective laser coagulation of placental vessels in twin-to-twin transfusion syndrome. The evidence for other fetal surgery interventions, such as tracheal occlusion in congenital diaphragmatic hernia, excision of lung lesions, fetal balloon cardiac valvuloplasty, and vesicoamniotic shunting for obstructive uropathy, is more limited. Conditions amenable to intrauterine surgical treatment are rare; the mother may consider termination of pregnancy as an option for many of them; treatment can be lifesaving but in itself carries risks to both the infant (preterm premature rupture of the membranes, preterm delivery) and the mother. This makes conducting prospective or randomized trials difficult and explains the relative lack of good-quality evidence in this field. Moreover, there is scanty information on long-term outcomes. It is recommended that fetal surgery procedures be performed in centers with extensive facilities and expertise. The aims of this review were to describe the main fetal surgery procedures and their evidence-based results and to provide generalist obstetricians with an overview of current indications for fetal surgery.
authors.affiliation: Trainee in Obstetrics and Gynecology, Department of Obstetrics and Gynecology, IRCCS A.O.U. San Martino IST, Genoa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Sala
authors.affiliation: Consultant, Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Prefumo
authors.affiliation: Consultant, Division of Obstetrics and Gynecology, Laboratory of Prenatal Diagnosis, IRCCS G. Gaslini Institute, Genoa, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Pastorino
authors.affiliation: Consultant, Division of Obstetrics and Gynecology, Laboratory of Prenatal Diagnosis, IRCCS G. Gaslini Institute, Genoa, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Buffi
authors.affiliation: Research Fellow, Division of Obstetrics and Gynecology, Laboratory of Prenatal Diagnosis, IRCCS G. Gaslini Institute, Genoa, Italy.
authors.forename: Chiara Roberta
authors.initials: CR
authors.lastname: Gaggero
authors.affiliation: Research Fellow, Division of Obstetrics and Gynecology, Laboratory of Prenatal Diagnosis, IRCCS G. Gaslini Institute, Genoa, Italy.
authors.forename: Marilena
authors.initials: M
authors.lastname: Foppiano
authors.affiliation: Consultant, Division of Obstetrics and Gynecology, Laboratory of Prenatal Diagnosis, IRCCS G. Gaslini Institute, Genoa, Italy.
authors.forename: Pierangela
authors.initials: P
authors.lastname: De Biasio
mesh_terms: D000013:Congenital Abnormalities / Q000601:surgery*; D004502:Education, Medical, Continuing; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D005315:Fetal Diseases / Q000601:surgery*; D005332:Fetoscopy / Q000193:education / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome