Intended for healthcare professionals

Clinical Review State of the Art Review

Prenatal regenerative fetoscopic interventions for congenital anomalies

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m1624 (Published 01 July 2020) Cite this as: BMJ 2020;370:m1624
  1. Rodrigo Ruano, professor in obstetrics & gynecology, physiology and pediatric, and chair of Maternal-Fetal Medicine Division
  1. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Center for Regenerative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  1. Correspondence to R Rodrigo ruano.rodrigo{at}mayo.edu; rodrigoruano{at}hotmail.com

Abstract

Fetal intervention has progressed in the past two decades from experimental proof-of-concept to practice-adopted, life saving interventions in human fetuses with congenital anomalies. This progress is informed by advances in innovative research, prenatal diagnosis, and fetal surgical techniques. Invasive open hysterotomy, associated with notable maternal-fetal risks, is steadily replaced by less invasive fetoscopic alternatives. A better understanding of the natural history and pathophysiology of congenital diseases has advanced the prenatal regenerative paradigm. By altering the natural course of disease through regrowth or redevelopment of malformed fetal organs, prenatal regenerative medicine has transformed maternal-fetal care. This review discusses the uses of regenerative medicine in the prenatal diagnosis and management of three congenital diseases: congenital diaphragmatic hernia, lower urinary tract obstruction, and spina bifida.

Footnotes

  • Series explanation: State of the Art Reviews are commissioned on the basis of their relevance to academics and specialists in the US and internationally. For this reason they are written predominantly by US authors

  • Financial support and competing interests: I acknowledge the financial support from the State of Minnesota (RMM 102516008). Dr R. Ruano is a recipient of the Regenerative Medicine Minnesota Clinical Trial grant: “Fetoscopic Regenerative Therapy for Severe Pulmonary Hypoplasia – a feasibility pre-randomized control trial study.”

  • Acknowledgments: I thank Dr Eniola R. Ibirogba, Dr Kavita Narang, Dr Michelle Wyatt, and Dr Andre Terzic for their contributions to the content and review of this manuscript. I also thank Ms. Jan H. Case for her work in preparing illustrations and the Mayo Clinic Library staff for their support with the literature search.

  • Provenance and peer review: commissioned; externally peer reviewed.

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