History of Fetal Therapy

Since the first attempts to diagnose birth defects before birth in the 1960’s and 70’s, there have been multiple approaches developed to try to treat some of the serious problems. Transfusions for severe anemia were developed in the 1960’s. The first attempts to perform open fetal surgery were performed in the mid 1980’s with the first successful repair of a diaphragmatic hernia in 1989 (Figure 1). The technique evolved from a complete repair of the diaphragm to temporary closure of the fetal trachea to build up fluids within the lung to expand it (Figure 2), to performing the procedure by fiberoptic scopes and plugs (Figure 3). After the repair, babies are delivered by a special type of Cesarean Section (EXIT procedure) to allow for the establishment of an airway and other surgical measures while the baby is still being given oxygen from the placenta (Figure 4)

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Open fetal surgery has moved on to repairs of certain lung malformations (congenital cystadenomatoid malformations – (figure 5)) and there is a large NIH trial currently underway for the repair of spina bifida (figure 6). Shunt procedures have been highly successful to treat obstructions of urine outflow from the fetal bladder as seen both on ultrasound (Figure 7) and endoscopically showing the urethra from inside the bladder (Figure 8).

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