OBJECTIVES

At the end of the course, students should be able to:

Understand the importance of a multidisciplinary approach to the diagnosis and management of fetal conditions, and how this serves as a model for modern medical management in general.
Understand the role of a multidisciplinary approach to fetal diagnosis in the peri- and postnatal management of the fetal and pediatric patient.
Understand the current options in fetal diagnosis and treatment (both noninvasive and invasive).
Understand the role of medical ethics in the decision-making process for the management of fetal conditions.
Formulate a plan of action for prenatal counseling, multidisciplinary involvement before birth and transition to peri- and postnatal management for common fetal conditions.

The seminar is divided into 16 sections over 8 1 ½ hour sessions. Each section covers an entity (diagnostic, therapeutic, ethical or other) within the field of fetal medicine (see addendum 1: Course schedule). Emphasis is placed on the multidisciplinary approach to fetal management. As such, the course will concentrate on those conditions for which fetal and/or neonatal intervention may be indicated, from gene therapy to fetal surgical intervention. The overarching concept of this course is the importance of a multidisciplinary approach to medical problems, a concept that has applications beyond the scope of fetal medicine. The following aspects of fetal medicine are covered:

1. Concepts of fetal medicine, and how this discipline differs from obstetrics (focus on mother and pregnancy, normal or not) and perinatology/maternal-fetal medicine (focus on 'at risk' pregnancies and the direct interaction between mother and fetus). In contrast, fetal medicine focuses on the often multidisciplinary approach to the "fetus as a patient," much the same way that a newborn, infant or child with a complex problem would be treated by pediatric medical and surgical specialists. The second portion of this section is devoted to medical ethics, and the specific problems related to mother vs. fetus, the rights of the fetus and the ethical aspects of (invasive) fetal treatment. (Goals covered - see above: 2, 4)
2. Embryology and fetal development, from the genetic concepts of organogenesis, homeobox genes, single gene and chromosomal anomalies; to the basis of abnormal fetal development and the embryological origin of congenital anomalies, as they apply to the fetus with complex (and potentially treatable) anomalies. (Goals covered: 1, 2)
3. Essentials of fetal diagnosis, mostly devoted to imaging (ultrasound and magnetic resonance imaging). Rather than a general description of fetal diagnosis, this section will be devoted to fetal imaging as a planning tool for multidisciplinary intervention. (Goals covered: 1, 2, 3)
4. Sessions IV through VI cover fetal anomalies by organ system. Session IV is divided between pulmonary and urological anomalies, with a focus on those conditions that can be diagnosed and/or treated in utero. (Goals covered: 1, 2, 3)
5. Hematological and cardiovascular anomalies. (Goals covered: 1, 2, 3)
6. Visceral, parietal and neurological anomalies. (Goals covered: 1, 2, 3)
7. This session covers the basic premise of fetal intervention, and the conditions that need to be met before invasive fetal therapy can be considered. A portion of this sessions is devoted to fetal intervention for complicated twin gestations. (Goals covered: 2, 3, 4)
8. Direct fetal therapy is addressed, from non- or minimally invasive forms, such as ultrasound-guided needle techniques and endoscopy, to the most aggressive form of fetal therapy, in utero surgery.