Current state of antenatal in utero surgical interventions.

Antenatal ultrasound scanning has facilitated the prenatal diagnosis of many fetal anomalies. The improved understanding of fetal pathophysiology, combined with increased accuracy of fetal diagnosis and knowledge of the clinical postnatal outcome, have culminated in the development of fetal treatment. This is usually considered when a potentially life threatening and/or disabling, but correctable, condition is diagnosed antenatally. The decision for fetal surgical intervention carries with it the potential of dual mortality (mother and fetus). Fetal anomalies can adversely aVect the mother by causing hypertension, oedema, and pulmonary failure. The condition, known as the maternal mirror syndrome, may prove fatal but appropriate fetal intervention can save the life of the mother. This syndrome has been reported in cases of antenatally diagnosed sacrococcygeal teratoma and cystadenomatoid malformation of the lung. The decision to undertake fetal intervention must be the prerogative of the mother. A clear explanation of the risk of survival and quality of life of the fetus with and without surgical intervention is essential. Maternal informed consent includes the risk of fetal intervention to the mother, although there have been no reported maternal deaths from open fetal surgery.