Ethical considerations

The fundamental conflict in fetal surgery is balancing the risks to both mother and fetus against the potential benefit to only the fetus.1 As the mother is an innocent bystander in the endeavour her involvement entails only risk. A major intervention to save the life of a fetus seems warranted if maternal risks can be minimised and good fetal outcome assured. 2 3 If one can minimise maternal risk by avoiding hysterotomy and its attendant lifelong risk of uterine rupture then a more minor improvement in fetal outcome might be tolerated. Fetal oversight committees have been created at most centres performing fetal surgery to act as multidisciplinary advisory and quality assurance committees. These committees review every single fetal surgical procedure performed in their institution. This nascent field is largely self regulated through the commitment of those involved in the International Fetal Medicine and Surgical Society.

Principles developed in the 1980s that underlie clinical application of …