Fetal surgery: new developments

Although most correctable malformations diagnosed in utero are still better managed by postnatal surgical treatment, in selected cases treatment before birth with fetal surgery may be the best option. Fetal surgery has been made possible by recent advances in fetal imaging, such as three-dimensional ultrasound and rapid acquisition magnetic resonance imaging. Recent advances in maternal anesthesia, tocolysis and technical aspects of surgery have also diminished the risks to the fetus and the mother. Successful fetal surgery treatment of lower urinary tract obstruction, congenital diaphragmatic hernia, congenital cystic adenomatoid malformation, bronchopulmonary sequetration and sacrococcygeal teratoma has been carried out over the past decade. Much of the progress in open fetal surgery has been made possible by applying new surgical, anesthetic and tocolytic techniques. It has been suggested that minimally invasive fetoscopic procedures will result in less uterine irritability and preterm labor and in reduced maternal and fetal risk.