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November 19, 1982

Fetal Surgery: Some Questions

JAMA. 1982;248(19):2498. doi:10.1001/jama.1982.03330190062035

The article by Frigoletto et al, appearing elsewhere in this issue (p 2496), is perhaps the vanguard of pioneering efforts at invasive care of the fetus. The precedent was set almost 20 years ago by Liley,1 who described successful intrauterine transfusion for severe erythroblastosis. Intrauterine transfusion never became commonplace because Rho(D) immune globulin greatly reduced the number of severely sensitized Rh-negative mothers. However, it has achieved an accepted place in the therapeutic armamentarium. Frigoletto et al report intrauterine diagnosis of hydrocephalus, with percutaneous placement of a ventriculoamniotic shunt under ultrasound guidance. The shunt decompressed the ventricles and allowed pregnancy to continue to a point where a viable newborn was delivered. That the baby later died of probably unrelated causes does not obscure the fact that the feasibility of intrauterine decompression of progressive hydrocephalus was established.

While the article further demonstrates the accessibility of the fetus to transabdominal manipulation, it