|Endoscopic access to the feto-placental unit: from experimental to clinical applications|
The unborn fetus is a patient susceptible of being diagnosed and treated. Most diagnostic and therapeutic available procedures are non-invasive. However, in some rare conditions there is the need for treating the fetus with surgery prior to birth, in order to prevent intra-uterine death or permanent sequelae. Recent technological advances have provided clinicians with new working instruments for the safe implementation of endoscopic procedures on the fetus or its placenta.
Fetoscopy represents an access modality to the unborn patient without removing it from its natural environment, with a minimally invasive procedure both for the mother and fetus. Several fetoscopic procedures have gained certain acceptance in selected centers worldwide, and they have saved fetuses that otherwise might have die in utero.
Therefore, fetoscopy may offer new perspectives in fetal therapy, but there is still a long way for research and development before its establishment in routine clinical practice becomes a reality. Fetoscopy is offering potentially effective therapies for conditions that now are associated to impressive mortality and permanent neurological damage in survivors. It seems mandatory to improve our knowledge on fetoscopic techniques to make them feasible in human pregnancy.
The Eurofoetus programme is a research project funded by the European Commission. Its aim is to develop and bring endoscopic procedures in pregnancy to routine clinical practice. The programme has been designed by a European working group on fetoscopy, involving both tertiary referral centers in fetal medicine and manufacturers of endoscopic material. To view the aims of the programme, see next page.