Introduction
Fetal therapy is defined as any prenatal treatment administered to the mother or fetus with the primary indication to improve perinatal or long-term outcomes for the fetus or newborn (1).
The practice of fetal therapy is a relatively new concept in the field of obstetrics. It originated over 55 years ago when Liley et al. first performed intraperitoneal transfusion for the treatment of fetal anaemia. Since then, the practice has evolved from open fetal surgery to minimally invasive techniques used to manage an array of complex conditions.As well as the clinical challenges of working with a small, mobile fetus, the concept of fetal therapy also evokes a number of ethical issues. These include balancing the benefit versus potential harm to the fetus, particularly in the setting of research where techniques have not yet proven to improve outcome. The majority of fetal therapies are associated with maternal consequences and as such it is extremely important to obtain fully informed consent when commencing treatment or performing surgery. Multiple pregnancies discordant for anomaly prove to be extremely challenging to manage as we face risking the health of one fetus to improve the outcome for another. More recently, the concept of fetal pain and ensuring adequate analgesia in utero has also been raised.
Fetal therapy now encompasses a wide range of techniques which can be broadly divided into five categories:
1. Transplacental therapy
2. Ultrasound-guided fetal therapy
3. Fetoscopic procedures
4. Open fetal surgery
5. Peripartum fetal therapy.