Fetal Treatment 2017: The Evolution of Fetal Therapy Centers - A Joint Opinion from the International Fetal Medicine and Surgical Society (IFMSS) and the North American Fetal Therapy Network (NAFTNet)

Abstract

More than 3 decades ago, a small group of physicians and other practitioners active in what they called “fetal treatment” authored an opinion piece outlining the current status and future challenges anticipated in the field. Many advances in maternal, neonatal, and perinatal care and diagnostic and therapeutic modalities have been made in the intervening years, yet a thoughtful reassessment of the basic tenets put forth in 1982 has not been published. The present effort will aim to provide a framework for contemporary redefinition of the field of fetal treatment, with a brief discussion of the necessary minimum expertise and systems base for the provision of different types of interventions for both the mother and fetus. Our goal will be to present an opinion that encourages the advancement of thoughtful practice, ensuring that current and future patients have realistic access to centers with a range of fetal therapies with appropriate expertise, experience, and subspecialty and institutional support while remaining focused on excellence in care, collaborative scientific discovery, and maternal autonomy and safety.

Fetal aqueductal stenosis: Prenatal diagnosis and intervention

“…A research agenda for a scientifically rigorous and ethically sound reassessment of the utility of ventriculoamniotic shunting that adheres to criteria set forth by the International Fetal Medicine and Surgery Society (IFMSS) 1982 and modified in 2017 has been proposed and is currently underway . A ventriculoamniotic shunt has been designed and tested in both in vitro and in vivo models that meet specific performance characteristics including (a) percutaneous, ultrasound‐guided placement; (b) low‐profile diameter to minimize the size of uterine and membrane puncture; (c) an anchoring mechanism to prevent migration; (d) a one‐way valve to prevent influx of amniotic fluid into the ventricular system; (e) sufficient compliance to prevent injury to intracranial or intraamniotic structures without kinking or obstructing and sufficient length and diameter to allow for CSF drainage while avoiding over‐drainage .…”

Maternal complications following open and fetoscopic fetal surgery: A systematic review and meta‐analysis

“…Fetal surgery poses risks to the mother not only during the procedure itself but also throughout the remainder of the index pregnancy, potentially during any future pregnancies and throughout the woman's entire life. Fetal surgery offers no direct medical benefit to the mother, and from an ethical perspective, maternal risks should be minor and acceptable to the mother and family …”

A study to assess global availability of fetal surgery for myelomeningocele

“…A later joint International Fetal Medicine and Surgery Society (IFMSS) and North American Fetal Therapy Network (NAFTNet) Opinion also recommended that all centres performing invasive fetal procedures should report their maternal, fetal, and newborn outcomes and that more formalised fetal intervention training should be developed.…”