Intrauterine surgery--choices and limitations.

Abstract

BACKGROUND:

The past decade has seen much progress in intrauterine surgery. Randomized trials have documented the benefit of some procedures of this type for the unborn child.

METHOD:

Selective literature review

RESULTS:

Randomized trials have demonstrated the benefit of fetoscopic laser coagulation of placental anastomoses in twin-to-twin transfusion syndrome (TTTS) and of intrauterine surgery via hysterotomy for the repair of spina bifida. Other fetoscopic procedures have yielded promising initial results but are not yet supported by findings from randomized trials. Some intrauterine surgical procedures must still be considered experimental in view of the lack of randomized trials and the rarity of the conditions they are designed to treat. Fetoscopic laser coagulation for TTTS is by far the most common procedure in fetal surgery; TTTS arises in roughly 1 in 2500 pregnancies. The other procedures discussed in this article are performed much less often and for rarer indications. In general, intrauterine surgery is indicated only to treat conditions that would otherwise lead to intrauterine death or irreversible prenatal damage.

CONCLUSION:

Intrauterine surgery is a rapidly developing field. Prenatal intervention by laser coagulation is indicated to treat severe TTTS, as its benefit has been shown in a randomized trial. Not enough evidence is yet available for the possible benefit of intrauterine surgery to treat myelomeningocele and congenital diaphragmatic hernia. Other indications are experimental. When an indication for intrauterine surgery exists, the parents should be informed and, depending on their wishes, referred to a center where it can be performed.

• Authors: Anke Diemert, Werner Diehl, Peter Glosemeyer, Jan Deprest, Kurt Hecher
• Journal: Deutsches Arzteblatt international (Dtsch Arztebl Int) Vol. 109 Issue 38 Pg. 603-38 (Sep 2012) ISSN: 1866-0452 [Electronic] Germany
• PMID: 23093990 (Publication Type: Journal Article, Review)

Topics

• Congenital Abnormalities (diagnosis, surgery)
• Female
• Fetal Diseases (diagnosis, surgery)
• Fetofetal Transfusion (diagnosis, surgery)
• Fetoscopy
• Humans
• Hysterotomy
• Infant, Newborn
• Laser Coagulation
• Pregnancy
• Spinal Dysraphism (diagnosis, surgery)