Foreword

Summary

Foreword

The history of fetal medicine has run a disorderly course, lacking in synchronicity. A landmark date is 1963, when William Liley published the first example of direct fetal therapy, intra-peritoneal blood transfusion for rhesus alloimmunization. This was long before the ultrasound technology that we regard as a sine qua non, and that we take for granted, was available. How much safer and more effective would the procedure have been with ultrasound guidance, at a time when hemolytic disease of the fetus was fairly common. Not long afterwards, rhesus porphylaxis was introduced and the condition became less frequent, just as its treatment with intravascular transfusion improved. It has now become so rare that it is difficult to provide training and to maintain skills.

Since then, there have been revolutions not only in ultrasound, but also in the laboratory sciences of biochemistry, cell culture, genetics, and molecular biology. These were embraced by fetal medicine, first for diagnosis and then for population screening and prevention of fetal conditions. Overwhelmingly, these are the main pre-occupations of fetal medicine and take place in all hospitals in the context of antenatal care. Fetal therapy has represented a far smaller area of activity (although the love affair of the media for fetal surgery might make one think otherwise!). h e reasons for this include the complexity and formidable nature of some of the interventions, the relatively rare indications and opportunities for performing them, and the limited availability of the necessary skills and facilities. The accumulation of knowledge and experience has therefore been slow and rightly has been restricted to highly specialized centers. There is, as yet, no definitive treatment for genetic disease, pre- or postnatally, and the understanding of the molecular basis for malformations is insufficiently advanced to design preventive strategies.