Fetal imaging and treatment: The current status of fetal surgery

Abstract

Fetal therapy should be performed for diseases that progress prenatally and result in fetal death or disability, ensuring that the benefits of treatment outweigh the risks associated with maternal and fetal invasiveness, or preterm delivery. Current fetal treatments are categorized according to their level of invasiveness into transplacental pharmacotherapy, ultrasound-guided procedures, fetoscopic surgery, and open surgery. Fetoscopic laser photocoagulation for twin-to-twin transfusion syndrome and fetoscopic endoluminal tracheal occlusion for congenital diaphragmatic hernia have been evaluated in randomized controlled trials primarily conducted in Europe. In the United States, open fetal surgery for myelomeningocele has been evaluated in a randomized controlled trial. In Japan, fetal thoracoamniotic shunting for fetal hydrothorax has been approved and covered by National Health Insurance following clinical trials. Additionally, clinical trials of open surgery to treat myelomeningocele and fetal aortic valvuloplasty for severe aortic stenosis are currently underway in Japan.