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Fetal surgery: an overview.
[congenital diaphragmatic hernia]
In
utero
fetal
surgery
interventions
are
currently
considered
in
selected
cases
of
congenital
diaphragmatic
hernia
,
cystic
pulmonary
abnormalities
,
amniotic
band
sequence
,
selected
congenital
heart
abnormalities
,
myelomeningocele
,
sacrococcygeal
teratoma
,
obstructive
uropathy
,
and
complications
of
twin
pregnancy
.
Randomized
controlled
trials
have
demonstrated
an
advantage
for
open
fetal
surgery
of
myelomeningocele
and
for
fetoscopic
selective
laser
coagulation
of
placental
vessels
in
twin-
to
-twin
transfusion
syndrome
.
The
evidence
for
other
fetal
surgery
interventions
,
such
as
tracheal
occlusion
in
congenital
diaphragmatic
hernia
,
excision
of
lung
lesions
,
fetal
balloon
cardiac
valvuloplasty
,
and
vesicoamniotic
shunting
for
obstructive
uropathy
,
is
more
limited
.
Conditions
amenable
to
intrauterine
surgical
treatment
are
rare
;
the
mother
may
consider
termination
of
pregnancy
as
an
option
for
many
of
them
;
treatment
can
be
lifesaving
but
in
itself
carries
risks
to
both
the
infant
(
preterm
premature
rupture
of
the
membranes
,
preterm
delivery
)
and
the
mother
.
This
makes
conducting
prospective
or
randomized
trials
difficult
and
explains
the
relative
lack
of
good-quality
evidence
in
this
field
.
Moreover
,
there
is
scanty
information
on
long
-term
outcomes
.
It
is
recommended
that
fetal
surgery
procedures
be
performed
in
centers
with
extensive
facilities
and
expertise
.
The
aims
of
this
review
were
to
describe
the
main
fetal
surgery
procedures
and
their
evidence-based
results
and
to
provide
generalist
obstetricians
with
an
overview
of
current
indications
for
fetal
surgery
.
Diseases
Validation
Diseases presenting
"amniotic band sequence"
symptom
congenital diaphragmatic hernia
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