The use of maternal/fetal ultrasound screening has become commonplace today. With progressive technical improvements and frequent usage, ultrasound is now used to accurately diagnose many fetuses with congenital anomalies prenatally. Ultrasound and other fetal diagnostic procedures are now used for a variety of diverse problems involving structural, genetic, and metabolic abnormalities. Invasive diagnostic procedures of the gravid uterus and amnion were used for a few decades. It has been only slightly more than 10 years since a team of pediatric surgical researchers primarily at the University of California at San Francisco (UCSF) explored the possibility of surgical fetal intervention for correction of anomalies.<sup>1 Adzick N.S., Harrison M.R. Fetal surgical therapy Lancet 1994 ;  343 : 897-902  [cross-ref]

Cliquez ici pour aller à la section Références, 3 Evans M.I., Adzick N.S., Johnson M.P. , et al. Fetal therapy—1994 Curr Op Obstetr Gynecol 1994 ;  6 : 58-64

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The principal idea behind fetal surgery evolves around the potential of correction or interruption of various abnormal processes that may bring about fetal demise or can become life-threatening or debilitating to the newborn. In certain instances, the availability of fetal intervention may dissuade the mother from electing to terminate the pregnancy. The initiation of fetal surgery research was based firmly on the concept that absolute maternal safety must be ensured.<sup>1 Adzick N.S., Harrison M.R. Fetal surgical therapy Lancet 1994 ;  343 : 897-902  [cross-ref]

Cliquez ici pour aller à la section Références</sup> In addition, the pregnancy had to be maintained for a considerable amount of time (weeks) to allow healing and reversal of the pathophysiologic processes. Complete uterine relaxation during the invasion of the amnion was a major hurdle to overcome. This was essential to ensure normal life-sustaining placental circulation.<sup>7 Mychaliska G.B., Bealer J.F., Graf J.L. , et al. Operating on placental support: The ex-utero intrapartum treatment (EXIT) procedure J Pediatr Surg 1997 ;  32 : 227-231  [cross-ref]

Cliquez ici pour aller à la section Références</sup> In a similar vein, it was quite important to provide tight closure of the uterus such that amniotic fluid leak is eliminated and to maintain postsurgical tocolytic therapy intended to keep the uterus from being overwhelmingly irritable and causing untimely abortion.

Fetal conditions for which actual intervention was carried out or for which advanced experimental studies have been completed include: urinary tract obstruction, congenital diaphragmatic hernia, congenital cystic adenomatoid malformation and bronchopulmonary sequestration, sacrococcygeal teratoma, and twin-to-twin transfusion.