Fetal Therapy
Rapid advances in imaging, genetics, and minimally invasive procedures have opened the door to interventions before birth, making Fetal Therapy one of the most complex and ethically charged areas of maternal–fetal medicine. This session examines how fetal therapies—from transfusions and shunt placements to fetoscopic surgery and experimental approaches—are selected, delivered, and evaluated. Participants will explore the balance between potential benefits for the fetus and risks for the pregnant person, with a strong emphasis on shared decision-making and multidisciplinary collaboration.
Clinicians attending Neonatology Conference are often seeking guidance on candidate selection, counselling, and evolving evidence. In this session, you will review indications for established procedures such as twin–twin transfusion syndrome treatment, in utero transfusions, and interventions for selected structural anomalies. The content will highlight diagnostic pathways involving detailed ultrasound, fetal MRI, echocardiography, and genetic testing, and how these inform prognostic discussions.
A core focus is designing integrated pediatric fetal therapy pathways that connect maternal–fetal medicine, neonatology, pediatric surgery, cardiology, neurology, and long-term pediatric follow-up. Participants will discuss how to organise case conferences, document options, and coordinate perinatal planning, including delivery location and immediate postnatal care. Emphasis is placed on honest, compassionate discussions about uncertainty, potential disability, and quality of life, as well as clear documentation of parental values and preferences.
The session also addresses research, ethics, and global access. Attendees will consider when therapies remain experimental, the importance of registries and long-term follow-up, and safeguards for informed consent. Challenges in low- and middle-resource settings, where advanced fetal therapy may be limited or unavailable, will be explored alongside opportunities for teleconsultation, training, and partnership. By the end, participants will have a nuanced understanding of fetal therapy’s possibilities and limitations, and practical tools for counselling and coordination.
Core Themes in Fetal Therapy
Diagnostic evaluation and case selection
- Using detailed imaging and genetic testing to clarify diagnosis, prognosis, and potential treatment options.
- Identifying which conditions are suitable for fetal intervention and which are better managed postnatally.
Procedural options and techniques
- Reviewing established and emerging interventions, their indications, and associated risks.
- Understanding anaesthesia, intraoperative monitoring, and post-procedure surveillance needs.
Counselling and shared decision-making
- Presenting information about benefits, risks, and uncertainties in balanced, sensitive ways.
- Exploring parental values, hopes, and worries to support informed, unpressured choices.
Perinatal planning and follow-up
- Coordinating delivery timing, location, and neonatal care plans that reflect anticipated scenarios.
- Planning long-term follow-up to monitor outcomes and refine practice.
Practice Insights and Service Organisation
Building pediatric fetal therapy pathways
Establishing multidisciplinary teams, referral criteria, and clear communication channels.
Embedding ethics and governance
Developing oversight structures and protocols for experimental or high-risk procedures.
Supporting parental emotional wellbeing
Providing psychological support, peer connections, and continuity of contact throughout the journey.
Collecting data and contributing to registries
Recording indications, procedures, complications, and outcomes to inform future care.
Addressing global disparities in access
Exploring partnerships, training, and telemedicine to extend expertise to more regions.
Integrating learning into neonatal and pediatric care
Ensuring information from fetal interventions is shared effectively with postnatal teams.
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