Download PDF
CC BY-NC-ND 4.0 · Journal of Fetal Medicine 2023; 10(04): 195-199
DOI: 10.1055/s-0044-1778736
SFM Practice Guidelines

SFM Fetal Therapy Practice Guidelines: Fetal Medical Therapy

Seneesh Kumar Vikraman 
1   Centre for Prenatal Diagnosis and Fetal Therapy, ARMC AEGIS Hospital Perinthalmana and Aster MIMS Hospital, Kottakal, Malappuram, Kerala, India
,
Reema Kumar Bhatt
2   Department of Fetal Medicine and Perinatology, Amrita Hospital and Research Centre, Faridabad, Haryana, India
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Fetal medical therapy encompasses a wide range of pharmacological interventions aimed at preventing, treating, or ameliorating specific pathological conditions in the fetus. In contrast to fetal surgery, fetal medical interventions involve administering drugs either through transplacental transfer (maternal oral, intramuscular or intravenous injections) or direct administration to the fetus (intraumbilical, intraamniotic, intramuscular, intraperitoneal and intracardiac). The available interventions can be divided into four categories depending on the impact it has on fetal well-being and physiology, conditions amenable to medical therapy with established benefits, drugs with likely or potential benefits, maternal drug therapy with indirect fetal benefits, and drugs administered for nontherapeutic benefits. Careful selection of the cases, discussion under an institutional review board or a multidisciplinary team, strict adherence to standard guidelines and recommendations, and performance by physicians with adequate expertise are mandatory.

Keywords

fetal medical therapy - fetal cardiac arrhythmias - dexamethasone - betamethasone - congenital hypothyroid goiters - Congenital toxoplasmosis - fetal analgesia

Informed Consent

Informed consent was obtained from all women.


Note

It is not an experimental research involving humans or animals.




Publication History

Article published online:
21 March 2024

© 2024. Society of Fetal Medicine. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Rosner G, Shachar SB, Yaron Y, Evans MI. Prenatal therapy of endocrine and metabolic disorders. In: Kurjak A, Chervenak FA. eds. Textbook of Perinatal Medicine: Volume 1. 2. Abingdon: Informa UK Ltd.; 2006: 803-812
    Google Scholar
  • 2 Donofrio MT, Moon-Grady AJ, Hornberger LK. et al; American Heart Association Adults With Congenital Heart Disease Joint Committee of the Council on Cardiovascular Disease in the Young and Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Council on Cardiovascular and Stroke Nursing. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation 2014; 129 (21) 2183-2242
    CrossrefPubMedGoogle Scholar
  • 3 Jaeggi ET, Carvalho JS, De Groot E. et al. Comparison of transplacental treatment of fetal supraventricular tachyarrhythmias with digoxin, flecainide, and sotalol: results of a nonrandomized multicenter study. Circulation 2011; 124 (16) 1747-1754
    CrossrefPubMedGoogle Scholar
  • 4 Karmegeraj B, Namdeo S, Sudhakar A, Krishnan V, Kunjukutty R, Vaidyanathan B. Clinical presentation, management, and postnatal outcomes of fetal tachyarrhythmias: a 10-year single-center experience. Ann Pediatr Cardiol 2018; 11 (01) 34-39
    CrossrefPubMedGoogle Scholar
  • 5 Cuneo BF, Zhao H, Strasburger JF, Ovadia M, Huhta JC, Wakai RT. Atrial and ventricular rate response and patterns of heart rate acceleration during maternal-fetal terbutaline treatment of fetal complete heart block. Am J Cardiol 2007; 100 (04) 661-665
    CrossrefPubMedGoogle Scholar
  • 6 Lajic S, Nordenström A, Ritzén EM, Wedell A. Prenatal treatment of congenital adrenal hyperplasia. Eur J Endocrinol 2004; 151 (3, Suppl 3): U63-U69
    CrossrefPubMedGoogle Scholar
  • 7 Mercè Fernández-Balsells M, Muthusamy K, Smushkin G. et al. Prenatal dexamethasone use for the prevention of virilization in pregnancies at risk for classical congenital adrenal hyperplasia because of 21-hydroxylase (CYP21A2) deficiency: a systematic review and meta-analyses. Clin Endocrinol (Oxf) 2010; 73 (04) 436-444
    CrossrefPubMedGoogle Scholar
  • 8 Mastrolia SA, Mandola A, Mazor M. et al. Antenatal diagnosis and treatment of hypothyroid fetal goiter in an euthyroid mother: a case report and review of literature. J Matern Fetal Neonatal Med 2015; 28 (18) 2214-2220
    CrossrefPubMedGoogle Scholar
  • 9 Balakrishnan B, Vikraman SK, Batra M, Chandra V, Kannoli G. A case of dichorionic twin pregnancy with maternal propylthiouracil induced hypothyroid goiter in both fetuses treated with intramniotic levothyroxine. J Foetal Med 2018; 5: 45-48
    Article in Thieme ConnectGoogle Scholar
  • 10 Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2017; 3 (03) CD004454
    PubMedGoogle Scholar
  • 11 FIGO Working Group on Good Clinical Practice in Maternal-Fetal Medicine. Good clinical practice advice: antenatal corticosteroids for fetal lung maturation. Int J Gynaecol Obstet 2019; 144 (03) 352-355
    CrossrefPubMedGoogle Scholar
  • 12 Hantoushzadeh S, Saleh M, Aghajanian S. Which corticosteroid is a better option for antenatal fetal lung maturation?. Pediatr Res 2022; 92 (04) 915
    CrossrefPubMedGoogle Scholar
  • 13 Bachnas MA, Akbar MIA, Dachlan EG, Dekker G. The role of magnesium sulfate (MgSO4) in fetal neuroprotection. J Matern Fetal Neonatal Med 2021; 34 (06) 966-978
    CrossrefPubMedGoogle Scholar
  • 14 Moise Jr KJ. Indomethacin therapy in the treatment of symptomatic polyhydramnios. Clin Obstet Gynecol 1991; 34 (02) 310-318
    CrossrefPubMedGoogle Scholar
  • 15 O'Brien B, Kesby G, Ogle R, Rieger I, Hyett JA. Treatment of primary fetal hydrothorax with OK-432 (Picibanil): outcome in 14 fetuses and a review of the literature. Fetal Diagn Ther 2015; 37 (04) 259-266
    CrossrefPubMedGoogle Scholar
  • 16 Chavkin Y, Kupfersztain C, Ergaz Z, Guedj P, Finkel AR, Stark M. Successful outcome of idiopathic nonimmune hydrops fetalis treated by maternal digoxin. Gynecol Obstet Invest 1996; 42 (02) 137-139
    CrossrefPubMedGoogle Scholar
  • 17 Anandakumar C, Biswas A, Chew SS, Chia D, Wong YC, Ratnam SS. Direct fetal therapy for hydrops secondary to congenital atrioventricular heart block. Obstet Gynecol 1996; 87 (5 Pt 2): 835-837
    PubMedGoogle Scholar
  • 18 Montoya JG, Remington JS. Management of toxoplasma gondii infection during pregnancy. Clin Infect Dis 2008; 47 (04) 554-566
    CrossrefPubMedGoogle Scholar
  • 19 Fisk NM, Gitau R, Teixeira JM, Giannakoulopoulos X, Cameron AD, Glover VA. Effect of direct fetal opioid analgesia on fetal hormonal and hemodynamic stress response to intrauterine needling. Anesthesiology 2001; 95 (04) 828-835
    CrossrefPubMedGoogle Scholar