References

Antiel RM, Curlin FA, Lantos JD Attitudes of paediatric and obstetric specialists towards prenatal surgery for lethal and non-lethal conditions. J Med Ethics. 2017; https://doi.org/https://doi.org/10.1136/medethics-2017-104377

Liley AW. Intrauterine transfusion of fetus in haemolytic disease. Br Med J. 1963; 2:1107-9

Rodrigues HCML, Van den Berg PP, Düwell M. Dotting the I's and crossing the T's: autonomy and/or beneficence? The ‘fetus as a patient’ in maternal–fetal surgery. J Med Ethics. 2013; 39:219-23 https://doi.org/https://doi.org/10.1136/medethics-2012-100781

Shanmuganathan M, Sival DA, Eastwood K-A Prenatal surgery for spina bifida: a therapeutic dilemma. Proceedings of the SHINE conference, Belfast. Ir J Med Sci. 2017; https://doi.org/https://doi.org/10.1007/s11845-017-1709-6

Stulberg DB, Dude AM, Dahlquist I Obstetrician-gynecologists, religious institutions, and conflicts regarding patient-care policies. Am J Obstet Gynecol. 2012; 207:73.e1-5

Prenatal surgery

02 January 2018
2 min read
Volume 26 · Issue 1

Abstract

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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