Treatment of the Fetus Home > Services We Offer
The past decade has seen an inevitable explosion in our understanding and knowledge of fetal physiology and disease patterns. The simultaneous development of ultrasound technology has enabled the identification of a higher number of fetuses with structural abnormalities, much earlier in pregnancy. Such diagnoses have therefore made possible the early correction of some abnormalities.

The baby can be treated in many ways depending on the pathology. Treatment can either be medical or surgical.
Methods of intra-uterine therapy
Medical Surgical

Trans-placental administration

Shunts

·  hydrocephalus

·  hydronephrosis

·  hydrothorax

Direct administration to the fetus

·  Blood transfusion

·  Drug treatment

·  Stem cell transfusion

Amnio-infusion

·  diagnostic

·  therapeutic

Fetal surgery

·  open

·  endoscopic

Some treatments can be administered directly into the fetus. One such example is intra-uterine transfusion of blood and blood products. Indeed, the most successful fetal therapy is the treatment of severe anaemia from Rhesus iso-immunisation by intrauterine fetal transfusions. The baby becomes seriously ill with anaemia due to anti D antibodies, which crosses the placenta to destroy the red blood cells of the baby.

Repeated transfusions of blood Group O negative are given until the baby reaches about 35 weeks, when the baby is delivered. This treatment allows a survival of up to 95% in these babies. Other blood products can also be transfused such as platelets in fetal thrombocytopenia (low platelet count).
Intra-uterine transfusion in progress.
Direct invasive fetal procedures have also been tried over the last decade. Shunts have been inserted in fetuses with bladder-outlet obstruction, fetal hydrothorax (water in the lungs), and congenital cystic adenomatous malformation of the lung. However, shunts are expensive, difficult to insert and often dislodges. Sometimes, serial aspirations are done.
Hydrothorax (a), excessive fluid in the lung (Hy) is
life threatening to the baby. Under careful
ultrasound surveillance, the needle is carefully placed into
the baby's chest (3-D image, b) and fluid is aspirated
into a syringe (c). Normal lung tissue re-expands (d).
Serial thoracocenteses may have to be performed
if the fluid re-accumulates.

With increasing use of assisted reproductive technology, there had been an increase in multiple pregnancies. Consequently, complications of multiple pregnancies are not uncommon. For example, twin-to-twin transfusion syndrome (TTTS), affects 10%-15% of monochorionic (identical) twins. In severe cases, the mortality is over 90%. Aggressive amnioreduction done serially can improve the survival up to 60%. However, fetoscopic laser coagulation of the communicating vessels has been shown to improve the survival rate to 75%-80%. This is now available in some hospitals in Malaysia.

Treatment of the baby is done as in-patient procedures. This means that you will have to be admitted to the hospital.

Amnio-reduction in progress
Twin-to-twin transfusion syndrome occurs in identical twin when there is an abnormal blood connection in the placenta they share.