Comprehensive Fetal Medicine Treatments

Fetal medicine treatments are specialized interventions aimed at managing or correcting certain conditions or abnormalities identified in the developing fetus during pregnancy. It’s important to note that not all conditions detected in utero have specific curative treatments, and in some cases, management may involve close monitoring and planning for appropriate postnatal care. Here are some common fetal medicine treatments:

• Amniocentesis and Chorionic Villus Sampling (CVS): These are diagnostic procedures rather than treatments, but they play a crucial role in fetal medicine. Amniocentesis involves sampling amniotic fluid, while CVS involves sampling placental tissue. These procedures help in diagnosing genetic disorders and chromosomal abnormalities.
• Intrauterine Blood Transfusions: If the fetus is diagnosed with severe anemia or blood disorders, such as Rh incompatibility, intrauterine blood transfusions may be performed. This involves transfusing compatible blood directly into the fetal circulation.
• Fetal reduction in twins,triplets or higher order pregnancies: Fetal reduction, also known as multifetal pregnancy reduction, is a procedure performed in cases of twins, triplets, or higher-order pregnancies to reduce the number of fetuses in the uterus. This procedure is typically recommended when there is a higher risk of complications for both the mother and the remaining fetuses if the pregnancy continues with multiple gestations.
• Fetal reduction multiple pregnancy (Monochorionic twins) by Radio frequency ablation (RFA )and Bipolar cord coagulation (BCC): Treatment of discordant twin like acardiac twin, or selective fetal growth restriction or any structural abnormality in one twin of a Monochorionic pregnancy
• Fetal Surgery:
  • In cases where structural abnormalities or life-threatening conditions are identified, fetal surgery may be considered. This involves performing surgical procedures on the fetus while it is still in the womb. Examples include treating twin-to-twin transfusion syndrome (TTTS), acardiac twin, discordant anomaly, or removing tumors.
  • Repairing spina bifida through either open or fetoscopic procedures is the most advanced fetal surgery in the recent era.
  • Fetoscopic tracheal occlusion (FETO) in cases of congenital diaphragmatic hernia (CDH)
  • Fetoscopic valvotomy/ valvo-plasty of  defective or stenosed fetal heart valves (aortic stenosis AS/ or pulmonary stenosis PS).
• Laser Ablation for Twin-to-Twin Transfusion Syndrome (TTTS): In cases of TTTS, where there is an uneven distribution of blood flow between identical twins sharing a placenta, laser ablation may be performed. This involves sealing off the blood vessels responsible for the unequal blood exchange to balance circulation.
• Shunt Placement: Shunts may be placed to address certain fetal conditions, such as hydrothorax (accumulation of fluid around the lung), fetal ascites (accumulation of fluid in the abdomen), and LUTO (lower urinary tract obstruction). This involves diverting excess fluid to the amniotic cavity, where it can be absorbed.
• Fetal Medication Therapy: Some medications may be administered indirectly (from mother to fetus) to address specific conditions. For example, medications may be used to treat fetal arrhythmias, congenital heart block, fetal infections like toxoplasmosis, syphilis, rubella, cytomegalovirus, HIV, etc.
• Cordocentesis (Percutaneous Umbilical Blood Sampling – PUBS): This procedure involves sampling fetal blood from the umbilical cord. It can be used for diagnostic purposes, such as assessing fetal blood gases, bilirubin, or performing transfusions.
• Maternal Medication: In some cases, medications administered to the mother may influence the well-being of the fetus. For example, medications may be prescribed to prevent hypertension in pregnancy or fetal growth restrictions, or to manage conditions  like gestational diabetes, preterm babies for lung maturity, or prevent preterm labor. It is important to emphasize that the decision to pursue fetal medicine treatments depends on the specific diagnosis, the severity of the condition, and the gestational age of the fetus.