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Journal Name Change

Vol. 1-4 (1986-1989) were published under the journal's former title Fetal Therapy.

Fetal Diagnosis and Therapy 2023, Vol. 50, No. 5
International Fetal Medicine and Surgery Society IFMSS 2022 Special Issue

Prelims

Fetal Diagn Ther (2023) 50 (5): 309–312. https://doi.org/10.1159/000534600

Systematic Review

Fetal Diagn Ther (2023) 50 (5): 313–331. https://doi.org/10.1159/000533634

Research Article

Fetal Diagn Ther (2023) 50 (5): 332–343. https://doi.org/10.1159/000530958

What does this study add to current knowledge?

• This study shows the minimally invasive application of a sealing patch to close fetal membrane (FM) defects induced by fetoscopy.

What are the main clinical implications?

• Currently, fetoscopy-induced FM defects cannot be treated, resulting in an increased risk for preterm prelabor rupture of the FMs (iPPROM) and preterm birth. The minimally invasive application of a sealing patch holds great promise for the prevention of iPPROM.

Fetal Diagn Ther (2023) 50 (5): 344–352. https://doi.org/10.1159/000531449
Mini-Summary

  • What does this study add to current knowledge?

  • This study provides important information for patients with gastroschisis regarding the incidence and possible risk factors for readmission.

  • What are the main clinical implications?

  • This study may assist clinicians to identify gastroschisis patients at higher risk of readmission and to provide additional education and follow-up.

Fetal Diagn Ther (2023) 50 (5): 353–367. https://doi.org/10.1159/000531535
Mini-Summary

  • What does this study add to the current knowledge?

    • Interviewing interprofessional clinicians from across the US who regularly provide maternal-fetal surgery counseling, we identified and characterized differing operational approaches (e.g., joint interdisciplinary vs. sequential specialty counseling), major counseling challenges (e.g., how to discuss patients’ psychosocial issues), and a lack of comprehensive evidence-based support to guide training and provision of this technically and emotionally complex patient communication.

  • What are the main clinical implications?

    • Despite clinicians’ dedication to ensure informed decision-making through effective and compassionate maternal-fetal surgery counseling, concerning gaps in evidence-based communication practices were found in critical areas (e.g., addressing patients’ grief and trauma, preventing maternal self-sacrifice, accounting for intersectional social determinants of health). In the absence of specific comprehensive communication training materials, maternal-fetal surgery counseling can be guided by evidence from fields such as perinatal loss and trauma-informed care, and further research to support best practices within maternal-fetal surgery must be conducted.

Fetal Diagn Ther (2023) 50 (5): 368–375. https://doi.org/10.1159/000531611
Mini-Summary

  • What does this study add to current knowledge?

    • This study reports a novel tool for predicting co-existing anomalies and clinical outcomes for VACTERL (vertebral, anorectal, cardiac, tracheoesophageal, renal, and limb) syndrome. It was developed using the largest series of VACTERL patients reported in the literature to date and has been validated on a second dataset.

  • What are the main clinical implications?

    • This easy-to-use assessment tool may improve counseling for families expecting a child with a prenatally diagnosed anomaly.

Fetal Diagn Ther (2023) 50 (5): 376–386. https://doi.org/10.1159/000531615
Mini‐Summary

  • What does this study add to current knowledge?

    • Ex-utero intrapartum treatment (EXIT) is utilized in cases where there is concern for neonatal cardiorespiratory compromise at birth. Given the relative infrequency of EXIT procedures, wide variations exist amongst North American Fetal Treatment Network (NAFTNet) centers regarding case selection and outcomes as well as suboptimal resource allocation.

  • What are the main clinical implications?

    • Lack of standardization of EXIT consultation and procedure performance amongst centers has resulted in poor resource allocation. This can cause both maternal and neonatal adverse outcomes, necessitating collection of more robust data and implementation of a more evidence-based approach.

Clinical Fetal Medicine

Fetal Diagn Ther (2023) 50 (5): 387–396. https://doi.org/10.1159/000530737
Mini-Summary

  • What does this study add to current knowledge?

    • There was a low rate of conversion to general anesthesia in patients undergoing minimally invasive fetal interventions for complex multiple gestations under monitored anesthesia care (MAC). Conversion to general anesthesia occurred in 2% (4/203, rate 95% CI: 0.00039, 0.03901) of patients who underwent fetoscopic selective laser photocoagulation. None of the patients undergoing radiofrequency ablation required conversion to general anesthesia. Patient movement under MAC was a common theme in those with conversion to general anesthesia.

  • What are the main clinical implications?

    • MAC may be preferable to general anesthesia in mid-gestation procedures because it is associated with exposure to lower medication doses and use of fewer medications. Parturients could be at risk of aspiration if they lose airway reflexes with a natural airway or if they have an unplanned conversion to general anesthesia. We found no serious adverse anesthesia-related respiratory events (e.g., aspiration) in patients who had successful procedures under MAC or in those with conversion to general anesthesia.

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