Special Articles

7.　Present and future of fetal therapy

Akio Kubota
Ex-organizing Chairman of the Japan Society of Fetal Therapy
Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health

Abstract

　The Japanese Society of Fetal Therapy was founded in 2003. The organizing chairmen were three obstetricians, one anesthesiologist, one pediatric surgeon and one pediatric cardiologist. Topics presented at the meetings included 1. medical therapy, e.g. anti-arrhythmics, 2. new techniques, e.g. fluorescein-endoscopy, laser-endoscopy, 3D-telescopy, and high-intensity focused ultrasound for fetal cardiac surgery, 3. fetoscopic laser photocoagulation（FLP）for twin to twin transfusion syndrome（TTTS）/ twin reversed arterial perfusion（TRAP）, 4. thoraco- and cysto-amniotic shunt, 5. ex-utero intra-partum treatment（EXIT）for congenital high-airway obstruction, cervical or oropharyngeal tumor, and 6. anesthesiology. Although new techniques have been developing rapidly, their practical application has been scantily reported.
　　To make fetal therapy a common practice for congenital disease, its indications should be established and ethical problems associated with it should also be continuously discussed. To establish the indications, two major projects are currently being carried on. One is to review the achieved fetal therapies and categorize them into three ranks; rank A includes those in which efficacy was proved by clinical studies, rank B includes those in which efficacy is expected but not proved, and rank C includes those in which efficacy is unclear. The other project is to distinguish those conditions which cannot be saved by conventional therapies after birth, and in which fetal therapy is indispensable to save them without serious sequelae.

Keywords：Fetal diagnosis, Fetal therapy, Fetoscopy, EXIT, Thoraco-amniotic shunt, Cysto-amniotic shunt