About the book
Since the first fetal surgery, in 1980, this area has made great progress, moving from experimental procedures to well-established surgeries. Advances in prenatal diagnosis provided by ultrasound have made it safer to perform fetal intrauterine surgeries. Observing ethical precepts supported by scientific evidence, an extraordinary development was observed in this field. Fetal procedures can be performed by open surgery or fetoscopy and the team must be multidisciplinary. The main indications are: fetal-fetal transfusion syndrome, acardic fetus, congenital diaphragmatic hernia, spina bifida, lower urinary tract obstruction, sacrococcygeal teratoma, pulmonary congenital lesions and fetal cardiac interventions. Surgical procedures can range from placing shunts to highly complex surgeries. Open surgery, mainly to correct myelomeningocele, shows an increase in maternal morbidity due to hysterotomy. Advances in fetoscopy reduce maternal morbidity and in some procedures are the routes of choice such as: laser photocoagulation of vascular anastomoses in monochorionic twin pregnancies with STFF, placement of the endotracheal balloon in cases of congenital diaphragmatic hernia and fetal cystoscopy in cases of obstruction of the lower urinary tract. However, in cases of spina bifida there is still no consensus between open surgery or fetoscopy.
The purpose of this book is to present the main indications for fetal surgery, the surgical techniques, the risks of the procedures bringing to the reader the state-of-the-art in fetal surgery.