Microsoft Word - FDT003BF.rtf

The fascination with the mystery of new life in utero dates from very early times. For example, Hippocrates made many astute original observations about pregnancy. However, the beginning of real understanding of fetal physiology and development processes is a relatively recent accomplishment. The development of ultrasound and its application to medical diagnosis has been a milestone in fetal medicine. New surgical techniques and the development of biological markers for early detection of fetal abnormalities have also contributed to significant advances in the area. These developments in research and technology have made it possible to detect congenital defects at very early stages of gestation. These powerful diagnostic tools, coupled with significant advances in surgical techniques, have given rise to a relatively new concept in medicine; the fetus as a patient. This new area of medicine seeks to provide effective intrauterine treatment which may uniquely prevent or ameliorate otherwise irreversible fetal defects in various congenital disorders. The fetus, therefore, becomes the central entity in terms of active therapy. In a sense, such treatment can be considered to be preventive medicine, since successful intrauterine therapy may prevent the devastating consequences of congenital defects in postnatal life. Antenatal diagnosis of a defective fetus presents three options to a physician. The first is not to intervene until birth, and hope to alleviate the problem postnatally. The second option is to terminate the pregnancy. The third option, which avoids the moral and psychological conflicts presented by the first two, is to intervene with some form of fetal therapy. Clearly, the third option is an attractive one but is far from universally accepted by the medical community. Given the relatively primitive level of our current knowledge, even the strongest proponents of fetal therapy would agree that many, perhaps most, congenital defects cannot be treated successfully in utero. However, there remains a significant number of fetal anomalies in which the results of treatment can be significantly improved by in utero intervention. Even in the case of favorable prognosis for treatment, there are many physicians who still insist on either of the first two options rather than risk a venture into the somewhat less familiar area of fetal medicine. This scepticism is a common phenomenon when a radically new approach appears. Physicians have the well-being of their patients as their 4 Michejda/Príngle