Advances in prenatal diagnosis have led to the prenatal management of a variety of congenital diseases. Fetal surgery was born of clinical necessity. Observations by pediatric surgeons and neonatologists of neonates that were born with irreversible organ damage led to the conclusion that one possible approach to prevent this alteration of developmental physiology, was fetal surgical intervention. The demonstration in animal models that the correction of an anatomical defect could reverse the associated pathophysiology led to the first systematic application of fetal surgery at the University of California, San Francisco, in the early 1980s . There has been a dramatic improvement in our ability to diagnose, select and safely operate on an expanding number of fetal anomalies. Many fetal interventions remain investigational but for a number of conditions randomized trials have established the role of in utero surgery, making fetal surgery a clinical reality in a number of fetal therapy programs. Although prenatal stem cell and gene therapy await clinical application, they offer tremendous potential for the treatment of many genetic disorders. Here we review the prenatal evaluation, current status and future potential of various prenatal operative approaches, such as open hysterotomy, fetoscopy, and percutaneous, including tissue engineering, and prenatal cellular and genetic therapy.
California ; Fetal Therapies ; Fetoscopy ; Genetic Therapy ; Humans ; Hysterotomy ; Infant, Newborn ; Models, Animal ; Prenatal Diagnosis ; San Francisco ; Stem Cells ; Tissue Engineering

No abstract available.
Catheters* ; Cystic Adenomatoid Malformation of Lung, Congenital* ; Fetal Therapies* ; Lung*

Fetal erythroblastosis caused by maternal Rhesus alloimmunization brings a significant clinical problem, eventually leading to fetal hydrops and intrauterine fetal death. Repeated blood transfusions into the umbilical vein are the treatment of choice for fetal erythroblastosis with severe hydrops. The purpose of this report is to introduce our experience with a case of fetal erythroblastosis, recovered after intraumbilical venous transfusions. The fetus has been received the intraumbilical venous transfusions for four times from 29 weeks of gestation. Fetal hydrops and cardiomegaly, as well as polyhydramnios were improved markedly after transfusions. A healthy baby was delivered at 34 weeks of gestation. Intraumbilical venous transfusion may be a safe and effective treatment on the case with severe aggressive anemic and hydropic isoimmune fetus.
Blood Transfusion ; Cardiomegaly ; Edema ; Erythroblastosis, Fetal* ; Fetal Death ; Fetal Therapies ; Fetus ; Hydrops Fetalis ; Infant, Newborn ; Polyhydramnios ; Pregnancy ; Umbilical Veins

The incidence of fetal cardiac arrhythmia is approximately 1-3%. Sustatined fetal tachyarrhythmia may cause fetal hydrops and rnay lead to fetal death. We experienced a case of fetal atrial flutter without fetal hydrops at 34 weeks of gestation, which was diagnosed by fetal echocardiography. Transplacental fetal therapy with maternal digoxin administration resulted in restoration of normal fetal sinus rhythm. At birth, the infant showed normal electrocardiographic finding with normal Apgar scores.
Arrhythmias, Cardiac ; Atrial Flutter* ; Digoxin ; Echocardiography ; Electrocardiography ; Fetal Death ; Fetal Therapies ; Humans ; Hydrops Fetalis ; Incidence ; Infant ; Mothers* ; Parturition ; Pregnancy ; Tachycardia

A case of fetal supraventricular tachycardia which caused fetal hydrops was diagnosed at 29 weeks of gestation by fetal echocardiography. Transplacental fetal therapy with ma-ternal intravenous digoxin administration resulted in restoration of normal fetal sinus rhythm and disappearance of fetal hydrops on 7th day after initiation of treatment when the mat-ernal serum digoxin level was 2.11 ng/mL. The fetus showed normal sinus rhythm when evaluated by fetal echocardiography during the remainder of pregnancy with maternal oral digoxin maintenence. At birth, the infant did not show any cardiac arrhythmia and hydropic appearance.
Arrhythmias, Cardiac ; Digoxin ; Echocardiography ; Fetal Therapies* ; Fetus ; Humans ; Hydrops Fetalis* ; Infant ; Parturition ; Pregnancy ; Tachycardia, Supraventricular*

We present a case of in-utero treatment of posterior urethral valve syndrome(PUVS) by vesicoamniotic shunting. The shunt was established by basket-shaped catheter at the 22 weeks' gestation. Enlarged bladder and hydronephrosis were improved after the shunt procedure. The baby was delivered at the 39 weeks' gestation and had normal serum range of BUN and creatinine. Because the outer opening of catheter was burried under abdominal skin on the day before delivery, posterior urethral valve excision and basket removal through urethra were operated by endoscopy on the 2nd day of birth. The baby has been followed up for 5 months and in good health. We report this case with a brief review of literature. Shunt operation in-utero is considered as a safe and effective therapy for lower urinary tract obstruction caused by PUVS.
Catheters* ; Creatinine ; Endoscopy ; Fetal Therapies* ; Hydronephrosis ; Parturition ; Pregnancy ; Skin ; Urethra ; Urinary Bladder ; Urinary Tract

The ex utero intrapartum treatment (EXIT) procedure was introduced to reduce fetal hypoxic damage while establishing an airway in fetuses with upper and lower airway obstruction. Delivery of the fetal head and shoulders while maintaining the uteroplacental circulation offers time to secure the fetal airway. Here, we report two cases of EXIT procedure for fetal airway obstruction, which were successfully managed with extensive preoperative planning by a professional multidisciplinary team.
Airway Obstruction* ; Fetal Therapies ; Fetus* ; Head ; Laryngeal Diseases ; Lymphangioma ; Placental Circulation ; Prenatal Diagnosis ; Shoulder

Fetal chylothorax is a rare congenital manifestation that shows variable clinical outcome ranging from complete spontaneous resolution to progression into hydrops or lung hypoplasia. There is no consensus in the literature as to the optimal antenatal management despite several complications such as preterm delivery, pulmonary hypoplasia, and perinatal death. Pleuroamniotic shunting has been the treatment of choice in fetal chylothorax. Recently, new fetal therapy such as OK-432 (Picibanil) pleurodesis is being introduced. Herein, we present two cases of women referred at early 2nd trimester because of fetal hydrothorax by routine ultrasonography. Cytology obtained by thoracocentesis revealed abundant lymphocytes, suggesting chylothorax. Effusion was aspirated and OK-432 (Picibanil) was injected into the pleural space of fetus. On follow up ultrasonography, the pleural effusion was nearly resolved by adhesion of the intrathoracic space and resulted in the delivery of a healthy neonate. Intrapleural OK-432 injection may be feasible therapeutic option for selected cases in early 2nd trimester with persistent chylothorax for effective control of pleural effusion with no adverse effects.
Chylothorax ; Consensus ; Edema ; Female ; Fetal Therapies ; Fetus ; Follow-Up Studies ; Humans ; Hydrothorax ; Infant, Newborn ; Lung ; Lymphocytes ; Picibanil ; Pleural Effusion ; Pleurodesis

OBJECTIVE: We report our experience with cordocentesis for prenatal diagnosis and therapy. The clinical effect and safety of cordocentesis were evaluated. MATERIALS AND METHODS: From June 1997 to December 2001, cordocentesis was performed on 461 fetuses at Asan Medical Center. The clinical characteristics of the patients and the results of each procedure were reviewed retrospectively. RESULTS: The mean gestational age at the time of cordocentesis was 25.0 weeks. The most common indication was rapid karyotyping (93.3%) and was followed by the risk of fetal infection (3.5%). Of 461 cordocentesis, 452 (98.0%) were done successfully at the first attempt. The procedure-related complications included transient bleeding at puncture site (0.7%), and transient fetal bradycardia (0.2%). There was no procedure-related fetal loss. The other obstetric complications were comparable with those in the general population. CONCLUSION: We conclude that cordocentesis is a useful, safe and effective procedure for fetal diagnosis and therapy.
Bradycardia ; Chungcheongnam-do ; Cordocentesis* ; Diagnosis ; Fetal Therapies ; Fetus ; Gestational Age ; Hemorrhage ; Humans ; Karyotyping ; Prenatal Diagnosis* ; Punctures ; Retrospective Studies

We experienced a case of fetal supraventricular tachycardia (SVT) with fetal ascites diagnosed at 29 weeks of gestation in 29 year-old primigravida woman. Transplacental fetal therapy with maternal oral antiarrhythmic agent (verapamil, diltiazem) resulted in restoration of normal fetal sinus rhythm and disappearance of fetal ascites. At birth, the infant did not show any cardiac arrhythmia and hydropic appearance.
Adult ; Arrhythmias, Cardiac ; Ascites* ; Diltiazem ; Female ; Fetal Therapies ; Humans ; Hydrops Fetalis ; Infant ; Parturition ; Pregnancy ; Tachycardia, Supraventricular* ; Verapamil