ABSTRACT
Fetal surgery corrects severe congenital anomalies in utero to prevent their severe consequences on fetal development. The significant risk of open fetal operations to the pregnant mother has driven innovation toward minimally invasive procedures that decrease the risks inherent to hysterotomy. In this article, we discuss the basic principles of minimally invasive fetal surgery, the general history of its development, specific conditions and procedures used to treat them, and the future of the field.
Subject(s)
Blood Transfusion, Intrauterine/methods , Congenital Abnormalities/surgery , Fetal Diseases/surgery , Fetofetal Transfusion/surgery , Fetoscopy/methods , Fetus/surgery , Amniotic Band Syndrome/surgery , Blood Transfusion, Intrauterine/history , Female , Fetal Therapies/history , Fetal Therapies/methods , Fetoscopy/history , Hernias, Diaphragmatic, Congenital/surgery , History, 20th Century , History, 21st Century , Humans , Laser Therapy/methods , Meningomyelocele/surgery , Minimally Invasive Surgical Procedures , Pregnancy , Surgery, Computer-Assisted , Ultrasonography, PrenatalABSTRACT
OBJECTIVE: To present an up-to-date review of the literature encompassing all important aspects of fetal transfusion for red blood cell alloimmunization in pregnancy. DATA SOURCES: A MEDLINE computer data base search was conducted for pertinent articles through August 1995. Additional publications were identified by cross-referencing. METHODS OF STUDY SELECTION: All pertinent references were reviewed by the authors, and their clinical significance in the fetal treatment of red blood cell alloimmunization was summarized. TABULATION, INTEGRATION, AND RESULTS: Fetal intraperitoneal transfusion in the treatment of severe red blood cell alloimmunization was first reported by Liley in 1963. Since then, major advancements have included intravascular techniques and fetal paralysis. A total of seven different approaches have been used. Case series describing fetal intravascular transfusion were reviewed, and outcomes were analyzed for all pregnancies and, separately, for those presenting with and without hydrops fetalis. Eighty-four percent of 411 fetuses that underwent intravascular transfusion had good outcomes. Ninety-four percent of nonhydropic fetuses and 74% of hydropic fetuses survived. Those with severe anemia but no hydrops at transfusion were five times more likely to survive than fetuses already hydropic. CONCLUSION: For pregnant patients presenting with severe red blood cell alloimmunization remote from term, fetal transfusion remains the best available therapeutic option. It is a safe procedure with a perinatal loss rate of approximately 1-3%, and overall neonatal survival exceeds 80%. It is the best available option until red blood cell alloimmunization can be prevented altogether.
Subject(s)
Blood Transfusion, Intrauterine , Erythroblastosis, Fetal/therapy , Blood Circulation , Blood Transfusion, Intrauterine/adverse effects , Blood Transfusion, Intrauterine/history , Blood Transfusion, Intrauterine/methods , Erythroblastosis, Fetal/physiopathology , Fetus/physiopathology , Forecasting , History, 20th Century , Humans , Infant, NewbornSubject(s)
Blood Transfusion, Intrauterine/history , Erythroblastosis, Fetal/therapy , Exchange Transfusion, Whole Blood/history , Blood Transfusion, Intrauterine/trends , Exchange Transfusion, Whole Blood/trends , Female , History, 20th Century , Humans , Infant, Newborn , Poland , Pregnancy , Prenatal Care/trendsABSTRACT
The circumstances under which Sir William Liley, KCMG, first conceived the idea of blood transfusion to mitigate temporarily the effects of severe haemolytic disease in an affected fetus, and carried it to a successful conclusion, all in a former war-time American army hospital, are presented. The significance of his achievement is estimated as being, not so much a major advance in the management of a serious fetal disease (which if left to itself would eventually disappear, albeit in millennia), but a first real demonstration that the fetus is accessible to skilled diagnosis and treatment, and thus has the inalienable right to be as much regarded as a patient as anybody else.
