A team of consulting professionals should be brought together in a collaborative and multidisciplinary fetal treatment program with established policies on communication, diagnostic and therapeutic interventions, and quality improvement. Members of the health care team should assist the parents in making an informed decision about fetal therapy. This is best accomplished by communicating directly with the parents to ensure that information is understood and that the parents are aware of the broad range of possible outcomes for both the pregnant woman and her fetus. This is extremely important because in their desire to simplify their understanding of fetal interventions parents may believe that a therapeutic intervention will result in either the death of the fetus or complete correction of the problem. Counseling should insure that parents understand the range of possible outcomes between complete cure and death.
Many techniques involving fetal intervention are of uncertain therapeutic efficacy.
Some fetal therapeutic interventions, such as prenatal steroids to prevent hyaline membrane disease and zidovudine to prevent the perinatal transmission of human immunodeficiency virus infection, are accepted practices of proven efficacy. 6,7 Other interventions, such as fetal transfusion for hydrops secondary to parvovirus infection, are common practices but are less certain in their efficacy. 8 Other fetal interventions, such as in utero repair of congenital diaphragmatic hernia, currently are considered research procedures and not standard medical practices. If a fetal intervention is one of proven efficacy and has concomitant low maternal risk, the physician should recommend the procedure and emphasize, if necessary, the responsibility of the mother to accept some personal risk for the potential benefit to her fetus. An example of such a procedure is the use of intrauterine fetal transfusions to prevent the complications of Rh isoimmunization.