A professional belief in basing practice on the best possible evidence can be complicated by moral or ethical views. George Winter explores one instance where opposing belief systems may collide
The first report of a prenatal intervention was made in 1963, when a life-saving intrauterine blood transfusion was undertaken on a fetus with severe haemolytic disease at 32 weeks gestation (Liley, 1963).
Since then, non-lethal conditions have been addressed with prenatal surgery. For example, Shanmuganathan et al (2017) reported on a 2016 conference organised by SHINE—the UK spina bifida charity—to consider the possible therapeutic pre- and postnatal dilemmas posed by the condition. Thus, one proponent of prenatal surgery, who described the results of open fetal surgery on 69 spina bifida cases over a 9-year period, reported that: ‘Shunt-dependent hydrocephalus at age 12 months was 21% in comparison to 52% in neonates operated on postnatally’ (Shanmuganathan et al, 2017: 2). However, a proponent of postnatal surgery suggested that ‘the selection criteria for prenatal surgery—regardless if open or fetoscopic—seemed to encompass the “easy” patients' (Shanmuganathan et al, 2017: 5). He observed that, in these cases, ‘postnatal surgery is also likely [to] provide a good outcome and that the most challenging patients from a neurosurgical point of view were in fact excluded from prenatal surgery.’
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