The enormous progress that has been made in prenatal medicine in recent years has resulted in the emergence of a number of new diagnostic and therapeutic methods that allow increasingly early detection and treatment of many fetal malformations - treatment in utero, i.e. before birth.
Intrauterine surgery for fetal hydrocephalus has already been carried out in many centres for several years. Hydrocephalus is caused by the accumulation of cerebrospinal fluid in the brain, the excess of which prevents normal brain development. By performing the operation in foetal life, the risk of fluid accumulation and impaired brain development can be significantly reduced. Intrauterine hydrocephalus operations involve the insertion of so-called 'shunts', which are connections between the dilated ventricles of the foetal brain and the amniotic cavity, allowing the fluid to drain properly. They are the most commonly performed intrauterine operations on the fetus.
Intrauterine procedures have also been used to treat some fetal heart defects. The risk of intrauterine or perinatal death of a baby with a heart defect is very high. Intrauterine intervention by a surgeon can reduce this risk. Several procedures have been carried out to correct fetal heart valve defects by dilating the valves, thus reducing the risk of serious blood circulation problems that endangered the fetus' intrauterine life.
It is likely that in the near future it will also be possible to perform surgery on the fetal face to correct defects such as cleft lip and palate. As the wounds from intrauterine operations heal very quickly and, most importantly, do not leave scars, this type of operation appears to be particularly beneficial. However, the intrauterine correction of this defect is the most controversial, due to the fact that intrauterine operations are operations with a very high risk of preterm birth and therefore of significant prematurity of the foetus, as well as many other complications. In this case, these risks may far outweigh the benefits of correcting this type of defect, especially as it is not a defect that is in any way life-threatening or disabling for the child. There are also known excellent results from the correction of such defects in the first years of the child's life, so it seems too risky to correct them in foetal life.
