This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Coleman, B. G. Articles by Iyoob, C. Search for Related Content PubMed PubMed Citation Articles by Coleman, B. G. Articles by Iyoob, C.

Fetal Therapy

State of the Art

Department of Radiology, The University of Pennsylvania Medical Center (B.G.C., S.C.H., J.E.L., H.L.N., S.D., C.I.), and Departments of Obstetrics and Gynecology (T.M.C., M.P.J.) and Pediatric Surgery (N.S.A., T.M.C.) and Center for Fetal Diagnosis and Treatment (L.H.), The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania.

Address correspondence and reprint requests to Beverly G. Coleman, MD, Department of Radiology, The University of Pennsylvania Medical Center, 3400 Spruce St, Philadelphia, PA 19104.

Objective. To review our experience with the use of sonography in evaluating potential candidates for in utero fetal therapy performed at The Center for Fetal Diagnosis and Treatment at The Children’s Hospital of Philadelphia. Methods. This review article was designed to discuss open hysterotomy for the 4 fetal surgical procedures that have been performed at our institution. The procedures included surgical repair of myelomeningocele, resection of sacrococcygeal teratoma in fetuses with nonimmune hydrops, resection of an enlarging congenital cystic adenomatoid malformation that is not amenable to thoracoamniotic shunting, and tracheal clip occlusion for severe left congenital diaphragmatic hernia. Results. For each surgical procedure, the use of sonography in the prenatal diagnosis of the congenital anomaly was detailed, as were indications for surgery and surgical procedures, postoperative monitoring and finally delivery, postnatal treatment, and long-term follow-up. Three of the procedures have been reasonably successful with rather dramatic results in some cases such that these techniques are still being performed. The 1 exception was open hysterotomy for the tracheal clip procedure for congenital diaphragmatic hernia, which has been abandoned. Conclusions. Fetal therapy is a rapidly evolving specialty, which is being practiced at several centers in this country. Sonography is an integral part of this specialty practice and has been used extensively in the diagnosis of some congenital anomalies that have debilitating or lethal consequences for the fetus. Technologic improvements in both sonography and magnetic resonance imaging have assisted tremendously in the many advances herein reported in the diagnosis and treatment of the above-described 4 congenital anomalies.

Key Words: fetal anomalies • fetal therapy • sonography

Abbreviations: AFP, -fetoprotein • BPS, bronchopulmonary sequestration • CCAM, congenital cystic adenomatoid malformation • CDH, congenital diaphragmatic hernia • EXIT, ex utero intrapartum treatment • LHR, lung-heart circumference ratio • MMC, myelomeningocele • MRI, magnetic resonance imaging • SCT, sacrococcygeal teratoma

This article has been cited by other articles:

				P. J. Woodward, R. Sohaey, A. Kennedy, and K. K. Koeller From the Archives of the AFIP: A Comprehensive Review of Fetal Tumors with Pathologic Correlation RadioGraphics, January 1, 2005; 25(1): 215 - 242. [Abstract] [Full Text] [PDF]