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Topic Title

  • Maternal-Fetal Surgical Procedures

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Abstract - Draft

Technical Brief: Fetal Surgery

Topic Abstract

Congenital abnormalities that can be repaired prenatally occur in approximately 2% of full term births and because of advances in imaging techniques such as ultrasound, many more congenital abnormalities are being diagnosed in utero. As these abnormalities are being more frequently recognized prior to delivery, maternal-fetal surgery has emerged as a potential option for treating some of these defects. However, it is largely unknown whether fetal surgical corrections provide safer and more effective care for the fetus when compared to post-natal surgery.  In addition, comparisons of fetal versus post-natal surgery must consider the safety of the mother and again, few comparative data exist. The issue is particularly complicated because while congenital defects in aggregate are relatively common, individual congenital abnormalities are much less common making effective study very difficult.  There are currently several trials sponsored by the NIH underway to evaluate some of the most common fetal surgeries.

The goal of the review is to identify the effectiveness of maternal-fetal surgery for several congenital abnormalities ranked of high importance by stakeholders and including:

  • Sacrococcygeal teratoma
  • Congenital diaphragmatic hernia
  • Thoracic lesions: congenital cystic adenomatoid malformation and bronchopulmonary sequestration
  • Obstructive uropathy
  • Myelomeningocele
  • Twin-twin transfusion syndrome
  • Cardiac malformations

The surgeries of greatest interest include open fetal surgery and fetoscopic surgery and their comparison to post natal surgeries.

Each of the conditions listed above is substantially distinct from the others and therefore, this review process will develop and present data separately for each. This will be a two-part parallel effort that combines a “traditional” systematic review process (including review of case studies) with a “grey literature” approach to answer questions of current practice, ongoing research and state of relevant technology.