[Are in-utero interventions justified? - perspective of neonatologists. - Part II. Spina bifida, obstructive uropathy, pleural effusion].

INTRODUCTION

Spina bifida, obstructive uropathy and congenital pleural effusion (PE) belong to the group of congenital defects in which attempts of in-utero treatment were undertaken.

OBJECTIVE

Main objective of our study was to search for scientific evidence that would justify offering, and performing, in utero interventions in fetuses with spina bifida, obstructive uropathy and PE.

METHODS

Using Pubmed as the main source, all publications relevant to the subject of in-utero interventions in fetuses with spina bifida, obstructive uropathy and PE were sought and carefully reviewed. An extra effort was made to identify all randomized controlled trials and meta-analyses.

RESULTS

Up to date, none of the aforementioned in-utero interventions was evaluated in the randomized controlled trial. Two ongoing studies, one for patients with spina bifida, and one for patients with obstructive uropathy are still actively recruiting the subjects. As suggested by the results of meta-analysis, vesico-amniotic shunt might be recommended for selected group of fetuses with obstructive uropathy. For fetuses with unilateral or bilateral PE, in-utero drainage seems to improve the outcome only in cases complicated by hydrops fetalis. However only case series are available.

CONCLUSIONS

Because of insufficient scientific evidence, offering in utero intervention to women with pregnancy complicated by spina bifida, obstructive uropathy and fetal PE on the routine basis is not justified. Until more data, preferably from randomized controlled trials are available, these procedures should only be performed in specialized centers as a part of carefully designed clinical trial.