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Fetal Therapy

Congenital adrenal hyperplasia is a recessively inherited disorder that results in salt wasting. Glucocorticoid replacement is lifesaving, and the long-term prognosis for these fetal surgery

The most successful and widely used form of invasive fetal therapy is the direct transfusion of erythrocytes to fetuses with erythrocyte isoimmunization. A transfusion can be directed into the peritoneal cavity or intravenously. The latter route has been used more extensively in recent years.

Anemia is the most common other reason to give a fetus erythrocyte transfusions. Anemia usually is discovered during examination of a fetus with nonimmune hydrops. If the fetus is found to be anemic from a reversible cause may be warranted. The most common etiologies for reversible underlying anemia are a maternal hemorrhage or parvovirus B19 infection with a resultant hemolytic crisis.

Obstructive Uropathy

Obstructive uropathy lends itself to early detection with ultrasonography. Posterior surgical management and surgery, urethral valves or bladder outlet obstructions are the most common of these disorders, but the obstruction may be at any level of the urinary tract.

Diaphragmatic Hernia

Diaphragmatic hernia is a serious anomaly with a high perinatal mortality rate. Although it may be associated with other anomalies, more frequently it is isolated. Death of neonates from pulmonary hypoplasia is believed to be due to compression of the normal lung in utero by herniated abdominal contents. Various methods of in utero repair have been proposed, including open fetal surgery. In this procedure, a hysterotomy is performed and the exteriorized fetus undergoes to repair the defect and allow normal lung development.