President Nakano, members of the Japanese Society of Perinatology, and guests, I am delighted to have the opportunity to visit you and share our experience with fetal diagnosis and treatment from the Fetal Treatment Center at the University of California, San Francisco.

 Here is the real star of the show. Until about the last 10 to 15 years or so, the human fetus was a very mysterious little creature who was hidden away inside the mother as a medical recluse. But recently, in large part due to advances in maternal ultrasound and a variety of other prenatal diagnostic techniques, we've learned that the human fetus can have serious problems and may need our help.

 As a pediatric surgeon, most of the babies with birth defects that I care for are now diagnosed before birth. And the fact that we can diagnose birth defects antenatally now permits other management options besides that of abortion. The foresight of knowing that there's a birth defect before birth may alter our management, whether it's the timing of delivery, the mode of delivery, or in the vast majority of cases, maternal transport, planned delivery, and care of the baby after birth. In a few rare circumstances, there is now the possibility of treatment before birth. So it's quite clear that the fetus is now a patient.

 This is a list of anatomic defects that have now been treated by fetal surgery at the University of California, San「Francisco. The basic concept is that these are simple anatomic defects that have predictable and sometimes disastrous effects on development. And it is particularly frustrating for me as a pediatric surgeon to take care of a baby with, say, urethral obstruction that's severe, and to realize in this newborn that I'm simply too late. The end organ damage, oligohydramnios-induced induced pulmonary hypoplasia and destroyed kidneys, occurred during the pregnancy. It's like so many other things that we see in medicine, if we had only treated the problem earlier. But in this case, the patient is still inside the Mom. So I'd like to review today what we've learned about the fetal management for fetuses with urinary tract obstruction, diaphragmatic hernia, congenital cystic adenomatoid malformation of the lung, and sacrococcygeal teratoma. And I'll begin with a discussion of congenital cystic adenomatoid malformation.