Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Center for Regenerative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
BMJ. 2020 Jul 1;370:m1624. doi: 10.1136/bmj.m1624.
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.
在过去的二十年中，胎儿干预已经从实验性的概念验证发展到了实践采用的、挽救先天性畸形胎儿生命的干预措施。这一进展得益于创新研究、产前诊断和胎儿外科技术的进步。与显著的母婴风险相关的侵入性开放式子宫切开术正逐渐被侵入性较小的胎儿镜替代。对先天性疾病的自然史和病理生理学的更好理解，推动了产前再生范式的发展。通过改变疾病的自然进程，即通过畸形胎儿器官的再生长或再发育，产前再生医学改变了母婴保健。本文讨论了再生医学在三种先天性疾病（先天性膈疝、下尿路梗阻和脊柱裂）的产前诊断和管理中的应用。
