Intrauterine Therapie – wie ist der Stand der Dinge?

Advances in prenatal ultrasound over the past 40 years have led to a significant increase in the detection rate of prenatal diseases but have also created the basis for intrauterine treatment in a subset of cases. As most prenatal interventions are associated with risks for both the fetus and the mother, they are reserved for diseases that have a fatal prognosis if left untreated, or face a significant deterioration during intrauterine development. To date, only a few of these therapeutic concepts have proven their value in controlled studies. These are, in particular, laser therapy for twin-to-twin transfusion syndrome, intrauterine closure of spina bifida, and tracheal occlusion for diaphragmatic hernia associated with severe pulmonary hypoplasia. Other intrauterine therapeutic approaches are less well documented, either due to the rarity of the condition or the lack of availability of instruments and appropriately experienced therapists. This article is intended to provide the primary consultant gynecologist with an overview of established procedures and recent developments.