Biochemical fetal therapy

Waves of enthusiasm for fetal therapy surrounded the earliest surgical interventions. With increasing experiences as detailed in other articles in this symposium, there has been considerable sobering of expectations of such surgical procedures. Conversely, selected medical and pharmacologic alterations in the milieu of the fetus appear to be promising and ultimately will probably become quite important in fetal therapy. Successes in medical fetal therapy have been clearly documented in two main areas: the prevention of external genital masculinization in female fetuses affected with 21-hydroxylase deficiency congenital adrenal hyperplasia (CAH) and the correction of fetal cardiac arrhythmias that can lead to nonimmune fetal hydrops and fetal death. In several other instances, it has been demonstrated that the pharmacology of the fetus can be altered although the usefulness of such alterations remains to be proved.