One in ten fetuses will present some problem during life in the mother’s womb. Many of those problems are mild but others are unfortunately severe and may compromise fetal survival or quality of life after birth. The benefit of prenatal diagnosis of fetal problems, whatever its severity may be, is today undisputed. A tailored management according to the best available knowledge results in substantial improvements in perinatal outcome for a wide range of mild and severe fetal conditions. On the other hand, in a proportion of severe fetal diseases a timely fetal intervention could save the fetus’ life or substantially improve its quality of life after birth. For cases where no treatment is available, detailed investigation of the causes of the problem is also essential in the planning of future pregnancies.

 

Thirty years ago, the fetus virtually did not exist in medicine. In late 70s, the introduction of ultrasound and the possibility to visualize the fetus in utero brought about a true revolution in two respects. For doctors, it allowed to diagnose in fetal life problems that until then had been only known in the newborn. For parents, it facilitated the recognition of the fetus as a person. The combination of these two factors resulted in the development of a new concept, the fetus as a patient, and with it, the beginning of a subspecialty that we know today as fetal medicine. Once the diagnosis was possible, it soon became evident that some of these fetal problems could be treated in utero. The ability to treat the fetus was called fetal therapy, a concept that now is an indissoluble part of fetal medicine proper.

Currently, fetal medicine is a field of enormous dimensions and with a very fast growth. The ever increasing development of ultrasound allows to see smaller and smaller details of fetal anatomy, or to study more and more complex aspects of the fetal life, such as fetal cardiac function. Fetal treatments are increasingly more sophisticated and the most clear example is fetal surgery, a mode of therapy now offered in a small groups of hospitals in Europe, including the Hospital Clínic in Barcelona. Fetal medicine has also provided different approaches and new solutions to the diagnosis and management of classical obstetrical problems, such as premature labor or fetal growth restriction.

Access to high quality fetal medicine is already a social demand. The perception of the fetus as a person makes parents with a fetal problem to expect a level of health care similar to what is offered to adults, with specialists who can guide them through the steps involved in diagnosis and therapy of fetal diseases. This goal is not always readily achievable, since fetal medicine hand fetal diseases are uncommon and require the participation of well trained subspecialists, often requiring high-level technology. These needs are normally addressed by fetal medicine referral centers.

Attention to fetal problems in modern referral centres pursues two main goals. On the one hand, to achieve the highest level of individualisation of management for each fetal case, through a high level of subspecialization. Secondly, to provide parents with the appropriate support, which implies a high quality information and appropriate psychological support.

In the years to come, the demands for a high quality fetal medicine and therapy will steadily increase, due to the growth of the three factors: (1) the continuous improvement in  diagnostic and therapeutic capabilities, (2) the increasing perception of the fetus as a person, resulting from better and more accurate imaging techniques, and (3) increasing public awareness and demands for advanced fetal medicine and therapy solutions, in the context of the global information society. The development of imaging techniques and of molecular medicine will allow diagnoses and treatments today unimagined. In the meantime, fetal medicine is today a reality, and we can offer parents accurate assessment for many fetal problems, and we can even solve some of these problems by means of fetal treatments, which over the last 20 years have saved the life of thousands of fetuses who are children today.