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Foetal therapies and their influence on preterm birth

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Abstract

Foetal therapy aims to improve perinatal survival or to prevent severe long-term handicap. Foetal medicine opens a new territory by treating the foetus as a patient. The mother has nothing to gain in terms of health benefits, yet she is inherently also undergoing treatment. In utero foetal interventions can be divided into ultrasound-guided minimally invasive procedures, fetoscopic procedures and open hysterotomy procedures, which carry an inherent risk of ruptured membranes and preterm birth. In this review, we summarise the conditions that may benefit from foetal therapy and review the current therapies on offer, each with their associated risk of ruptured membrane and preterm birth. We also look into some risk limiting and preventative strategies to mitigate these complications.

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Abbreviations

CDH:

congenital diaphragmatic hernia

CPAM:

congenital pulmonary adenomatoid malformation

FETO:

foetal endoscopic tracheal occlusion

FLC:

fetoscopic laser coagulation

GA:

gestational age

IUT:

intrauterine transfusions

LUTO:

lower urinary tract obstruction

MFR:

multifetal pregnancy reduction

OFS:

open foetal surgery

OSB:

open spina bifid

PTB:

preterm birth

PPROM:

preterm prelabour rupture of membranes

RFA:

radiofrequency ablation

SCT:

sacrococcygeal teratoma

TRAP:

twin reversed arterial perfusion

TTTS:

twin-to-twin transfusion syndrome

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Authors and Affiliations

  1. Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven University of Leuven, Leuven, Belgium

    Ignacio Valenzuela, Johannes van der Merwe, Luc De Catte, Roland Devlieger, Jan Deprest & Liesbeth Lewi

  2. Department of Obstetrics and Gynaecology, Division Woman and Child, University Hospitals Leuven, Leuven, Belgium

    Johannes van der Merwe, Luc De Catte, Roland Devlieger, Jan Deprest & Liesbeth Lewi

  3. Institute for Women’s Health, University College London, London, United Kingdom

    Jan Deprest

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  1. Ignacio Valenzuela
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All authors have contributed to the conception and drafting of the article. All authors have read and agreed to the final version of the manuscript.

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This article is a contribution to the special issue on Preterm birth: Pathogenesis and clinical consequences revisited - Guest Editors: Anke Diemert and Petra Arck

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Valenzuela, I., van der Merwe, J., De Catte, L. et al. Foetal therapies and their influence on preterm birth. Semin Immunopathol 42, 501–514 (2020). https://doi.org/10.1007/s00281-020-00811-2

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