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.

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 …

Fetal surgery

The management of congenital tracheal stenosis.

Long-segment tracheal stenosis: slide tracheoplasty and a multidisciplinary approach improve outcomes and reduce costs.

Tracheoplasty for long segment congenital tracheal stenosis: analysis of 29 patients over two decades

Pediatric Tracheal Stenosis

CDH is a common congenital anomaly that occurs in 1 in 2000 to 5000 births. 1-5 In 90% of cases abdominal viscera herniate into the left hemithorax through the foramen of Bochdalek. 2 Less often, the abdominal viscera herniate into the right hemithorax. Rarely, defects in both hemidiaphragms or complete absence of the diaphragm occur. Prenatal diagnosis in these latter situations can be challenging but is important because the mass effect of bilateral lesions on the developing lungs leads to an extreme degree of pulmonary hypoplasia. Unfortunately, the usual findings used to detect fetuses with CDH may be absent, surprisingly subtle, or frankly confusing in this most extreme situation. We present two cases of prenatal sonography in fetuses with bilateral CDH. In the first case an erroneous diagnosis of unilateral CDH was made. The correct diagnosis was made in the second case. These cases illustrate the pitfalls leading to diagnostic error and the clues leading to a correct prenatal diagnosis.

Prenatal diagnosis of bilateral diaphragmatic hernia: diagnostic pitfalls.

Tracheal stenosis: the long and the short of it.

Minimal access fetal surgery.

Congenital diaphragmatic hernia associated with a gastroesophageal duplication cyst: a case report.

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Papers

Prenatal diagnosis of bilateral diaphragmatic hernia: diagnostic pitfalls.

Tracheal stenosis: the long and the short of it.

Minimal access fetal surgery.

Congenital diaphragmatic hernia associated with a gastroesophageal duplication cyst: a case report.