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Keywords:

  • congenital diaphragmatic hernia;
  • fetal alloimmune thrombocytopenia;
  • gene therapy;
  • lower urinary tract obstruction;
  • stem cell transplantation;
  • twin-to-twin transfusion syndrome

Key content

  • Fetal medicine is a rapidly developing subspecialty.
  • The mainstay of treatment for fetal alloimmune thrombocytopenia remains maternal immunoglobulin therapy.
  • Stem cell transplantation and gene therapy have advanced over the last decade but must still be considered experimental.
  • Laser coagulation is the best treatment for all stages of twin-to-twin transfusion syndrome presenting before 26 weeks of gestation.
  • Fetoscopic endoluminal tracheal occlusion appears to improve prognosis in severe congenital diaphragmatic hernia.

Learning objectives

  • To gain an overview of the recent developments in fetal therapy.
  • To understand the benefits and risks of different methods of fetal therapy.
  • To appreciate the importance of high-quality research in fetal medicine.

Ethical issues

  • With the option of fetal therapy, the value and implications of prenatal diagnosis have to be reviewed.
  • The acceptability of fetal therapy to parents and to society should be investigated.
  • The consideration of the mother and fetus as individual people presents an inherent difficulty in implementing randomised controlled trials in fetal medicine.

Please cite this article as: Morris RK, Chan BC, Kilby MD. Advances in fetal therapy. The Obstetrician & Gynaecologist 2010;12:94–102.