Benefits of fetal surgery must be carefully evaluated

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7033.780a (Published 23 March 1996) Cite this as: BMJ 1996;312:780
  1. Mark D Kilby,
  2. Martin J Whittle
  1. Senior lecturer Professor Division of Fetal Medicine, Academic Department of Obstetrics and Gynaecology, Birmingham Maternity Hospital, Birmingham B15 2TG

    EDITOR,—The expanding role of intrauterine fetal surgery is creating much interest.1 At the fetal medicine centre in Birmingham we have performed an intrauterine angioplasty for critical pulmonary stenosis, which led to the birth of a viable baby (J Wright et al, meeting of Fetal Medicine and Surgery Society, Belgium, 1994).

    Fetal surgery should be used only in properly evaluated cases and when the prognosis of postnatal correction is poor. In his editorial on fetal surgery Francois I Luks uses intrauterine treatment of congenital diaphragmatic hernia as an illustration. At our regional fetal therapy unit we reviewed 48 consecutive cases of congenital diaphragmatic hernia referred between 1988 and 1995 and found that, once babies with coexistent anomalies and karyotypic abnormalities had been excluded, half of the babies survived (unpublished findings). Thus the benefits of prenatal surgery may not be that much greater than those of traditional management in appropriately selected cases. Any intrauterine surgery should be assessed by randomisation of cases to traditional or prenatal surgery and by the establishment of a register noting both perinatal and maternal mortality and morbidity.

    Disappointingly, the editorial makes no mention of the need to improve our understanding of the natural course of congenital anomalies. Surely greater emphasis should be placed on this if real progress in fetal survival is to be made.

    We look forward to participating in the acquisition and analysis of potentially exciting data.


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