Fetal Surgery Ural\'s Scientific School

Abstract

Over the past three decades, great progress has been made in our ability to diagnose fetal abnormalities, predict their outcome, and to perform surgical interventions. The concept of the fetus as a patient has become a standard of care and the ethical framework for maternal fetal intervention is well developed. This is a report on pilot study of 6 years experience in fetal surgery and fetoscopic manipulations performed in Maternity and Child Care Research Institute (Yekaterinburg, Russia). During this period a total of 286 intrauterine blood transfusions in rhesus hemolytic fetuses were successfully performed. Nephro-amniotic shunting was performed in 28 fetuses with severe urinary tract obstruction. All newborn infants, which are alive now, underwent postnatal surgical correction. The technique of fetoscopic laser vascular coagulation was used for the treatment of sacrococcygeal teratoma (six cases). The lethal diaphragmatic hernia was diagnosed in 12 fetuses and fetoscopic balloon tracheal occlusion was performed in six cases with effectiveness of 50%.About 112 laser coagulations of the vascular placental anastomoses were performed for the treatment of twin-twin transfusion syndrome with effectiveness of 76%. The technical approaches to fetoscopic interventions and treatment of spina bifida were developed in six experiments on fetal lambs.In its formative years, fetal surgery has been considered as experimental or innovative therapy. However, fetal surgery, as all medical and surgical therapy, needs to be validated by outcome-based research, which is an objective of future research development.