Benachi Alexandra, Vivanti Alexandre J
Division of Obstetrics and Gynecology, APHP- Paris Saclay University Hospitals, Antoine Béclère Hospital, Clamart, France.
Paris Saclay University, Le Kremlin Bicêtre, France.
Eur J Pediatr. 2024 Dec 30;184(1):110. doi: 10.1007/s00431-024-05922-8.
Unlike any other medical field, fetal medicine addresses two patients: the fetus and the mother. Its primary goal is to improve neonatal outcomes, specifically by reducing mortality and morbidity, including long-term impacts, while minimizing risks to the mother. The aim of fetal interventions for life-threatening malformations is to decrease morbidity and mortality by mitigating the impact of the malformation on fetal growth and development. Although some randomized controlled trials have evaluated fetal medicine procedures, they have faced challenges such as the rarity of most conditions and ethical concerns related to clinical equipoise. Prematurity, an intrinsic risk of membrane puncture, remains a significant burden of fetal surgery, and maternal safety must always be prioritized when considering such procedures. Despite 50 years of research in fetal medicine, many questions remain, due to advancements in ultrasound technology and genetics, the inherent risks associated with fetal procedures, the lack of appropriate medical device for rare diseases and the cost associated with conditions that require complex multidisciplinary neonatal care. Justice and parental autonomy must be respected but the principle of non-maleficence should prevail.
与其他任何医学领域不同，胎儿医学涉及两名患者：胎儿和母亲。其主要目标是改善新生儿结局，特别是通过降低死亡率和发病率，包括长期影响，同时将对母亲的风险降至最低。针对危及生命的畸形进行胎儿干预的目的是通过减轻畸形对胎儿生长发育的影响来降低发病率和死亡率。尽管一些随机对照试验对胎儿医学程序进行了评估，但它们面临着一些挑战，如大多数病症的罕见性以及与临床 equipoise 相关的伦理问题。早产是胎膜穿刺的固有风险，仍然是胎儿手术的重大负担，在考虑此类手术时，必须始终优先考虑母亲的安全。尽管胎儿医学已经研究了50年，但由于超声技术和遗传学的进步、胎儿手术固有的风险、缺乏针对罕见疾病的适当医疗设备以及与需要复杂多学科新生儿护理的病症相关的成本，许多问题仍然存在。必须尊重公正和父母自主权，但不伤害原则应占上风。
