Fetuses with congenital malformations can be helped by surgical intervention while still in the womb. The potential of intrauterine surgery to improve their chances of survival is described by Anke Diemert and her co-authors in the latest issue of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2012; 109(38): 603). This kind of intervention is indicated only in fetuses with diseases that would lead to intrauterine death or to damage not amenable to postnatal repair.
Studies have shown a particularly high benefit of fetoscopic laser coagulation in twin-to-twin transfusion syndrome. Specialized centers can nowadays achieve survival of both twins in 70% and of at least one twin in 90% of cases. Intrauterine surgery also improves the prognosis of fetuses with spina bifida. Further fetoscopic treatments remain experimental and are not generally indicated for the time being.
This having been said, the authors view fetal surgery as a dynamically developing field and urge all affected parents to seek expert advice.