Current status of fetal surgery

Fetal surgery has come a long way since its inception in 1980s.1 It has evolved from open laparotomy to minimally invasive techniques over the last three decades. As prenatal diagnosis becomes more sophisticated, the list of conditions amenable to fetal therapy will expand. Level I evidence from trials such as Eurofetus2 and MOMS3 have firmly placed fetal therapy as the standard of care for these hitherto untreatable conditions. Evidence from these trials has also answered many questions regarding maternal safety in fetal surgery. In the Indian context, there is an urgent need to increase awareness amongst obstetricians, sonologists and the public about treatable fetal conditions. It is equally important to establish referral pathways to dedicated centres so that patients who need and want fetal therapy are not denied the opportunity and are able to access treatment at the earliest. Only tertiary care centres equipped with the logistics and expertise in terms of a multidisciplinary 'perinatology' team including maternal-fetal medicine specialist, pediatric cardiologist, pediatric surgeon, pediatric urologist and neonatologist experienced in looking after sick and operated babies, should be offering fetal therapy. Since the case load of these uncommon conditions will always remains low, there is a need to establish a formal pathway directing patients to designated centres where fetal therapy is offered under strict protocols and guidelines. Formulation of a Fetal Surgery Society will be invaluable in achieving this.