Fetal Treatment 1982

Mr, Harrison; Ra, Filly; Ms, Golbus; Rl, Berkowitz; Pw, Callen; Tg, Canty; Catz, Charlotte; Wh, Clewell; Depp, Richard; Ms, Edwards; Jc, Fletcher; Fd, Frigoletto; Wj, Garrett; Ml, Johnson; Jonsen, Albert R.; Aa, De Lorimier; Wa, Liley; Mj, Mahoney; Fd, Manning; Pr, Meier; Michejda, Maria; Dk, Nakayama; Nelson, Lara; Jb, Newkirk; Pringle, Kevin C.; Rodeck, C; Ma, Ru; Jd, Schulman

doi:10.1056/nejm198212233072623

Cited by 198 publications

(73 citation statements)

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“…3 On the basis of these studies, fetal intervention was undertaken at numerous medical centers, and the International Fetal Surgery Registry was established. 10 The initial enthusiasm for fetal intervention may have been premature. Results from the animal research did not necessarily come to fruition when performing similar procedures in humans.…”

Section: Discussionmentioning

confidence: 99%

Fetal Surgery for Posterior Urethral Valves: Long-Term Postnatal Outcomes

2001

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ABSTRACT. Objective. Fetal intervention for obstructive uropathy was first performed at the University of California, San Francisco in 1981. Indications for treatment were bilateral hydronephrosis with oligohydramnios. Preintervention criteria included fetal urinary electrolytes with ␤-microglobulin levels, karyotyping, and detailed sonography specifically looking for renal cortical cysts. We reviewed the outcomes of children who underwent fetal intervention with specific long-term follow-up in patients who were found postnatally to have posterior urethral valves.

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Section: Discussionmentioning

confidence: 99%

Fetal Surgery for Posterior Urethral Valves: Long-Term Postnatal Outcomes

2001

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“…Vesicoamniotic shunting (VAS) in LUTO became popular in the early 1980s with the rationale of diverting the obstructed bladder into the amniotic cavity in order to prevent damage to the compressed organs such as kidneys. This enthusiasm followed successful intrauterine surgery in animal models and the development of shunting catheters which can be placed percutaneously under ultrasound guidance into the maternal abdomen under local anesthesia (Harrison et al 1982). However, cumulative experience has long been difficult to compile with different meanings given to the word successful.…”

Section: Managing Uncertaintymentioning

confidence: 99%

“…Prenatal assessment of fetal malformations or diseases acts as a strong incentive for prenatal intervention, as well as raising some significant ethical issues (Smadjor et al, 2011). Although the first fetal intrauterine blood transfusion was performed in the early 1960s, the concept of the fetus as a patient and the justification for direct fetal intervention rapidly developed in the early 1980s (Harrison et al, 1982). Fetal therapy may be considered a possibility when the anomaly is diagnosed at an early stage and when what is known of its natural history suggests that the most likely outcome is either perinatal death or severe morbidity or disability despite optimal postnatal management.…”

Section: Introductionmentioning

confidence: 99%

Fetal therapy: practical ethical considerations

Ville

2011

Prenatal Diagnosis

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Progress in prenatal diagnosis can lead to the diagnosis of severe fetal abnormalities for which natural history anticipates a fatal outcome or the development of severe disability despite optimal postnatal care. Intrauterine therapy can be offered in these selected cases. Prenatal diagnosis is the only field of medicine in which termination is an option in the management of severe diseases. Fetal therapy has therefore developed as an alternative to fatalist expectant prenatal management as well as to termination of pregnancy (TOP). There are few standards of fetal care that have gone beyond the stage of equipoise and even fewer have been established based on appropriate studies comparing pre-and postnatal care. Several ethical questions are being raised as fetal surgery develops, including basic Hippocratic principles of patients' autonomy and doctors' duty of competence moving the boundaries between experimental surgery, therapeutic innovation and standard care. In addition, the technical success of a fetal intervention can only rarely fully predict the postnatal outcome. Managing uncertainty regarding long-term morbidity and the possibility for fetal therapy to change the risk of perinatal death into that of severe handicap remains a critical factor affecting women's choice for TOP as an alternative to fetal therapy.

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“…Myelomeningocele is the most common form of congenital central nervous system defect compatible with life, affecting an estimated 5 to10 pregnancies per 10,000 in the United States, prenatal repair for which results in improved neurofunctional outcomes as compared to postnatal repair (14,15). In the criteria for fetal surgery developed by the International Fetal Medicine and Surgery Society, a multidisciplinary team should necessarily be established (16). The entire multidisciplinary team should include members from the diagnostic imaging, obstetrics, pediatric surgery, anesthesiology, maternal fetal medicine, neonatology, nursing, and social work (17).…”

Section: Scenariomentioning

confidence: 99%