[Prenatal path of care following the diagnosis of a malformation for which a novel prenatal therapy is available]

Abstract

Objectives: Fetal therapy is part of the available care offer for several severe malformations. The place of these emergent prenatal interventions in the prenatal path of care is poorly known. The objective of this study is to describe the decision-making process of patients facing the option of an emergent in utero intervention.

Methods: We have conducted a retrospective monocentric descriptive study in the department of maternal-fetal medicine of Necker Hospital. We collected data regarding eligibility or not for fetal surgery and the pregnancy outcomes of patients referred for myelomeningocele, diaphragmatic hernia, aortic stenosis and low obstructive uropathies.

Results: All indications combined, 70% of patients opted for fetal surgery. This rate was lower in the case of myelomeningocele with 21% consent, than in the other pathologies: 69% for diaphragmatic hernias, 90% for aortic stenoses and 76% for uropathy. When fetal intervention was declined, the vast majority of patients opted for termination of pregnancy: 86%. In 14% of the considering fetal surgery, the patient was referred too far.

Conclusion: The acceptance rate for fetal surgeries depends on condition. It offers an additional option and is an alternative for couples for which termination of pregnancy (TOP) is not an option. Timely referral to an expert center allows to discuss the place of a fetal intervention and not to deprive couples of this possibility.

Keywords: Acceptability; Acceptabilité; Chirurgie fœtale; Congenital diaphragmatic hernia; Decision; Diagnostic prénatal; Décision; Fetal aortic stenosis; Fetal surgery; Hernie de coupole diaphragmatique; Lower urinary tract obstruction; Myéloméningocèle; Mégavessie; Neural tube defects; Prenatal diagnosis; Sténose aortique.