Invasive Fetal Therapy: Global Status and Local Development

Abstract

There are few congenital anomalies that can be treated in utero, despite the rapid development of fetal medicine. The number of available antenatal treatments is growing with the advance of supplementary tools, especially ultrasound and endoscopy. Disorders involving accumulation of excessive fluid in the amniotic cavity (polyhydramnios), chest (hydrothorax), abdomen (ascites) and urinary system (obstructive uropathy) are regularly treated using aspiration or shunt drainage under ultrasound monitoring. Electrolyte solutions or concentrated blood component supplements are used to treat oligohydramnios (amnioinfusion and amniopatch) and fetal anemia (fetal transfusion). Placental tumor (chorioangioma) and fetal tumors (cystic hygroma and sacrococcygeal teratoma) are also successfully treated by antenatal injection of medications. Fetoscopic procedures, especially obstetric endoscopy, are now used regularly in North America, Europe, Australasia and Japan after the validity was established in the treatment of twin-twin transfusion syndrome when compared with traditional amnioreduction. However, most procedures involving surgical fetoscopy or open fetal surgery remain experimental. Their validity and efficacy are not confirmed in a number of fetal diseases for which they were claimed to be effective. A brief review of the global status and history of invasive fetal therapy is given, and its status in Taiwan is also described. Future development in this field relies on greater understanding of the basic physiology and pathology of the diseases involved, as well as on the progress of sophisticated instrumentation.

Keywords

• thoracoamniotic shunt
• vesicoamniotic shunt
• fetal transfusion
• amnioinfusion
• amnioreduction
• fetoscopy
• open fetal surgery
• hydrops fetalis
• cystic hygroma
• twin-twin transfusion syndrome