Indications and Procedures (Magill’s Medical Guide, Sixth Edition)
As early as the 1960’s, some unborn infants suffering from progressive anemia caused by antibodies that drew away their strength were saved by receiving blood transfusions in utero. These early procedures marked the beginnings of invasive medical intervention in dealing with fetal problems.
Not until the technical advances of the 1970’s and beyond, however, was it possible to observe human fetuses in the uterus. With the development of ultrasound imaging, it became possible to examine in considerable detail the size, growth, and contour of fetuses. The use of ultrasound enabled physicians to assess with considerable accuracy the age of fetuses, their probable date of birth, and a number of congenital abnormalities, such as spina bifida.
Laparoscopes with diameters of less than 0.1 inch make it possible to examine the fetal stomach. The use of lasers and tiny instruments guided by computers has allowed methods of fetal surgery that were inconceivable at mid-twentieth century. These instruments greatly reduce blood loss in all types of surgery, including fetal surgery, and greatly improve the prognosis in such procedures. They are used to repair ruptured membranes in fetuses, to install shunts to relieve blockages, and, with the laser excision of placental vessels, to equalize osmotic pressure in twin-twin transfusion syndrome.
It has become possible for obstetricians to observe all significant...
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Uses and Complications (Magill’s Medical Guide, Sixth Edition)
As fetal surgery becomes more significant and more common in the treatment and elimination of many threatening prenatal conditions, numerous complications, both ethical and physical, necessarily arise. Any surgery involves risk, and in fetal surgery a dual risk exists: risk to the fetus and risk to the mother. Therefore, physicians who perform fetal surgery have simultaneously as patients both prospective mothers and fetuses. Because fetuses cannot speak for themselves or make their own decisions, fetal surgeons often find themselves in an ethical quagmire. Most physicians hesitate to recommend fetal surgery except in such extreme cases that fetal death or severe disability without such surgery seems inevitable.
Sometimes wrenching decisions must be made about whether to save the life of the mother or the life of the fetus. Questions also arise about whether to allow a fetus to come to term if it is obvious that it will suffer from birth defects that will either severely limit the length of its life or adversely compromise its quality of life, which in some cases may involve a normal life span. Many notable people who suffered from severe birth defects have made significant contributions to society and have led productive and rewarding lives.
One of the more significant uses of fetal surgery is in the treatment of twin-twin transfusion syndrome. In the United States, this syndrome occurs in about one thousand...
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Perspective and Prospects (Magill’s Medical Guide, Sixth Edition)
The development of highly specialized instruments, including fiber-optic telescopes and instruments specially designed to enter the uterus through minute incisions, has made possible the field of fetal surgery. Obstetrical surgeons can now correct life-threatening defects and malformations through the smallest, least invasive of openings while the fetus remains within the protection of the mother’s body. This procedure, referred to as fetoscopic surgery, is the method preferred whenever it is possible because it reduces substantially the danger of bringing about premature labor at a time when the fetus cannot breathe on its own.
Because fetal surgery is in its infancy, relatively few surgeons specialize in it and the full range of its uses and promises has yet to be explored. The two major centers in the United States that have pioneered development in this field are the Children’s Hospital in Philadelphia and the University of California Hospital in San Francisco.
Considerable research in fetal surgery is being conducted at both of these institutions and in laboratories and hospitals throughout the country. It is a matter of time before improved technology will exist to eradicate some of the major barriers to more extensive fetal surgery. Surgery of all kinds is becoming less invasive, which reduces considerably the shock that it delivers to patients’ bodies, including blood loss and recovery time....
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For Further Information: (Magill’s Medical Guide, Sixth Edition)
Barron, S. L., and D. F. Roberts, eds. Issues in Fetal Medicine: Proceedings of the Twenty-ninth Annual Symposium of the Galton Institute, London, 1992. New York: St. Martin’s Press, 1995. Chapter 7, “Fetal Surgery,” by Don K. Nakauyama, and chapter 8, “Fetal Therapy,” by Martin J. Whittle, deal directly with matters relating to fetal surgery, clearly outlining the medical problems that it is generally directed toward treating. In chapter 1, “The Galton Lecture for 1992: The Changing Status of the Fetus,” Barron also touches briefly on intravenous transfusion and limited exchange transfusion in utero.
Harrison, Michael, et al. The Unborn Patient: The Art and Science of Fetal Therapy. 3d ed. Philadelphia: W. B. Saunders, 2001. Deals with correcting hydrocephalus through fetal surgery that results in the reduction of fluid in the brain.
O’Neill, J. A., Jr. “The Fetus as a Patient.” Annals of Surgery 213 (1991): 277-278. This brief editorial raises cogent ethical concerns surrounding fetal surgery.
Wise, Barbara, et al., eds. Nursing Care of the General Pediatric Surgical Patient. Gaithersburg, Md.: Aspen, 2000. Of particular relevance is chapter 9, “Fetal Surgery,” by Lori J. Howell, Susan K. Von Nessen, and Kelli M. Burns, which explores the varieties of surgeries generally performed on fetuses.
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