Prenatal surgery

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.’