The last half century has seen extraordinary advances in fetal medicine. Prematurity, preeclampsia, diabetes, rhesus disease and rubella took a large toll on perinatal survival. In those days amniocentesis, ultrasonography and cardiotocography were not yet available. Knowledge of fetal physiology and pathology was sparse. In 50 years since, the fetus has been thoroughly studied with new modalities being introduced that helped us understand the fetus better. Advances in fetal imaging, genomics, and minimally invasive techniques, as well as a better understanding of the natural history of many fetal diseases, mainly from animal studies, have over the past few years revolutionized the management of many fetal conditions diagnosed prenatally.
Now perinatal mortality has decreased significantly, with babies born at 23 weeks having a chance of surviving whereas in the past babies born at gestation ages less than 34 weeks had a slim chance of survival. Rhesus disease has decreased remarkably and fetal aneuploidy can be detected by prenatal genetics in the first trimester. The rapid advances in embryology have increased our understanding of the processes involved in different organ formation. For decades pediatric surgeons agonized over their inability to save babies from deadly defects after birth. Since 1981, when Harrison performed a pioneering in utero procedure to treat a fetal urinary-tract obstruction, hundreds of fetuses have undergone treatments ranging from tumor removal to spinal-cord repair.
Some operations have been dramatic successes, saving the lives of babies who would otherwise have died. Others have been heart-wrenching failures. In no other medical area are the stakes—two patients, not just one—so high. Now repairs of congenital diaphragmatic hernia, temporary tracheal occlusion for diaphragmatic hernia, fetoscopic laser treatment of A-V communication in twin-to-twin transfusion syndrome can be performed in-utero. Today's state of the art ultrasound machines are equipped with 3 D and 4 D ultrasound technology. The introduction of this technology enabled physicians to add a new dimension to gynaecological and obstetrical ultrasound imaging. 4-D Ultrasound System takes 3-D images of the fetus and adds another dimension: time, resulting in a trueto-life image. Conditions like cleft lip/palate, cysts, scoliosis, hand anomalies, skeletal malformations, spinal bifida and heart defects can be clearly seen.