[Fetal therapy and fetoscopy: A reality in clinical practice in 2015]

Abstract

Both the improvement of pathophysiological knowledge of major fetal anomalies and the development of therapeutic tools have allowed in some specific cases in utero therapy by foetoscopy. We discuss the state of art and recent advances for four major anomalies: twin-to-twin transfusion syndrome, congenital diaphragmatic hernia, myelomeningocele and lower urinary tract obstruction. Fetoscopic laser surgery for twin-to-twin transfusion syndrome has become the gold standard for treatment of TTS. In terms of fetal surgery, severe congenital diaphragmatic hernia and myelomeningocele are the two main indications, even if open fetal surgery is still the gold standard for management of myelomeningocele. New techniques using fetal cystoscopy are currently under development. Although the maternal morbidity associated with foetoscopy is low, preterm rupture of membranes and preterm delivery remain an important problem. Long-term evaluation of those neonates remains mandatory.

Keywords: Chirurgie fœtale; Congenital diaphragmatic hernia; Fetal surgery; Fetoscopy; Fœtoscopie; Grossesses monochoriales; Hernie de coupole diaphragmatique; Lower urinary tract obstruction; Monochorionic twins; Myelomeningocele; Myéloméningocèle; Pathologies obstructives du bas appareil urinaire.