ABSTRACT

Lethal Anomaly 52

4. Obstructive Uropathy 54

5. Sacrococcygeal Teratoma 60

6. Myelomeningocele 62

7. Tension Hydrothorax 63

8. Congenital Heart Defects 65

9. Premature Rupture of Membranes 68

10. Amniotic Band Syndrome 69

11. Gastroschisis 69

12. Potential Future Applications of Minimal Access Fetal

Surgical Technique 70

References 71

The rapid advances over the last 20 years in prenatal imaging and diagnosis, coupled with

an increased understanding of the pathogenesis of neonatal disease, has led to the identi-

fication of the fetus as a patient and to the burgeoning field of fetal surgery. An increasing

number of select fetal anomalies are currently amenable to prenatal intervention

(Table 5.1). Life-threatening congenital anomalies have been historically treated by

open fetal surgical techniques. Yet, a variety of significant complications including pre-

term labor (PTL), premature rupture of membranes (PROM), pre-term delivery and

maternal complications from the tocolytic therapy have lead surgeons to investigate inno-

vative approaches to minimize these complications. In order to reduce maternal morbidity

related to the hysterotomy and fetal morbidity due to exposure and manipulation, minimal

access surgical techniques have been adapted to the fetal environs. Minimal access fetal

surgery (MAFS) may allow for a broader applicability of fetal intervention, and extension

of treatment to nonlethal and highly morbid fetal maladies.