Foetal therapies and their influence on preterm birth
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REVIEW
Foetal therapies and their influence on preterm birth Ignacio Valenzuela 1 Liesbeth Lewi 1,2
& Johannes van der Merwe
1,2
& Luc De Catte
1,2
& Roland Devlieger
1,2
& Jan Deprest
1,2,3
&
Received: 29 June 2020 / Accepted: 26 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Foetal therapy aims to improve perinatal survival or to prevent severe long-term handicap. Foetal medicine opens a new territory by treating the foetus as a patient. The mother has nothing to gain in terms of health benefits, yet she is inherently also undergoing treatment. In utero foetal interventions can be divided into ultrasound-guided minimally invasive procedures, fetoscopic procedures and open hysterotomy procedures, which carry an inherent risk of ruptured membranes and preterm birth. In this review, we summarise the conditions that may benefit from foetal therapy and review the current therapies on offer, each with their associated risk of ruptured membrane and preterm birth. We also look into some risk limiting and preventative strategies to mitigate these complications. Keywords Foetal therapy . Foetal medicine . Fetoscopy . Foetal surgery . Preterm birth . Premature rupture of membranes
Introduction
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Due to the significant advances in prenatal imaging and invasive testing techniques, an increasing number of structural, functional and genetic foetal anomalies are being diagnosed before birth. Some of these conditions will be lethal and will not benefit from any treatment, whereas most cases can wait to be treated after birth. However, selected cases will benefit from in utero treatment. In this context, foetal therapy aims to treat life-threatening conditions, to prevent permanent organ damage or to impede disease progression. The principles to offer foetal therapy of prenatally diagnosed congenital anomalies are as follows [1]:
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This article is a contribution to the special issue on Preterm birth: Pathogenesis and clinical consequences revisited - Guest Editors: Anke Diemert and Petra Arck * Liesbeth Lewi [email protected] 1
Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium
2
Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Leuven, Belgium
3
Institute for Women’s Health, University College London, London, United Kingdom
An accurate diagnosis and possible staging, with the exclusion of associated anomalies A well-documented natural history and prognosis The lack of an effective postnatal therapy Proof of feasibility and efficacy in animal models Interventions performed in specialised multidisciplinary foetal treatment centres within strict protocols and approval of the local ethics committee with informed consent of the mother or parents.
Foetal therapy opens a new territory by treating the foetus as a patient. The mother has nothing to gain in terms of health benefits from foetal therapy, yet she is inherently also und
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