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Fetal surgery

BMJ 2003; 326 doi: (Published 01 March 2003) Cite this as: BMJ 2003;326:461

Several conditions are proving amenable to treatment in this nascent field

  1. Diana Farmer, professor
  1. University of California San Francisco Fetal Treatment Center, Department of Surgery, HSW 1601, 355 Parnassus Avenue, San Francisco, California 94123, USA

    Most disorders diagnosed before birth are best managed by treatment after birth. However, a few diseases with predictable devastating developmental consequences may benefit from fetal treatment. Surgical intervention on the human fetus has been performed for more than two decades in the United States, primarily at two centres. Recently, fetal surgery has become an international endeavour, with nearly a dozen centres worldwide. Also until recently, only fetuses with life threatening defects were considered candidates for prenatal correction. Now fetal surgical procedures are being performed for non-lethal conditions. Despite the expansion of fetal surgery, several ethical considerations still linger.

    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 …

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