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December 1989

Fetal Surgery in the 1990s

Author Affiliations

From the Division of Reproductive Genetics, Departments of Obstetrics/Gynecology and Molecular Biology and Genetics, Hutzel Hospital, Wayne State University, Detroit, Mich (Dr Evans); the Department of Obstetrics and Gynecology, Ram Bam Medical Center, Haifa, Israel (Dr Drugan); the Department of Obstetrics and Gynecology, University of Manitoba, Winnipeg, Canada (Dr Manning); and the Fetal Treatment Program and Division of Pediatric Surgery, University of California, San Francisco (Dr Harrison).

Am J Dis Child. 1989;143(12):1431-1436. doi:10.1001/archpedi.1989.02150240053016

In the recent past, the first opportunity to visualize fetal structure and function occurred at birth. Two major contributions in the 1960s inaugurated the era of the fetus as a patient: (1) Prenatal diagnosis became possible using amniocentesis as a technique to evaluate fetal health by cytogenetic1 and biochemical2,3 analysis. (2) Prenatal treatment became possible using fetal transfusion to control rhesus factor erythroblastosis fetalis.4 Intrauterine exchange transfusions through an open abdomen and uterine incision were attempted and abandoned due to unacceptably high maternal morbidity associated with "open" procedures.5 The development of less invasive techniques for percutaneous placement of catheters or needles for intraperitoneal transfusion permitted in utero exchange transfusion.6

In the 1970s, the introduction of fetal ultrasonography allowed for accurate visualization of the structure and function of the fetus.7 As skill and technology advanced, the list of fetal anomalies able to be diagnosed by

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