F oetal therapy is an emerging, rapidly growing trend in the field of perinatology. Pregnant uterus remained a source of mystery until 1960s when technological advancement in imaging came up. The first successful therapeutic foetal pro- cedure was reported by Sir AW Liley, who transfused a hydropic foetus with Rh disease in 1965. Later on Dr Michael Harrison and his team at the University of California did the first open foetal surgical proce- dure in 1982 for obstructive uropathy. The PubMed search shows nearly 122158 entries in response to foetal therapy while applying AND OR NOT strategy. Global estimates suggest that congenital anoma- lies affect 2-3 percent of births among which most common anomalies are of cardiovascular system on central nervous system. According to the recent SRS 2018 data of Registrar General of India 4.6 percent of total infant deaths in India were due to birth defects. Congenital anomalies constitute the fifth largest cause of neonatal mortality in India, but national es- timates on the prevalence of these conditions are lacking. Currently there are various foetal therapeu- tic modalities that can help a foetus to grow inside the womb and survive later on while minimising the effect of congenital problems. In India, few private hospitals are equipped in pro- viding foetal therapy e.g. Apollo Centre for Foetal Medi- cine, New Delhi, CIMAR Cochin, Amrita Institute of Medical Sciences and Research Centre, Kochi etc. Nursing care of a pregnant mother with complica- tions are itself unique challenge to nurses. Nurses working in the field of maternity or neonatal care take special care of the pregnant woman and the unborn along with specialised neonatal care later. What is Foetal Therapy? It is a therapeutic intervention undertaken for the purpose of correcting or treating a foetal anomaly or condition. Criteria for Foetal Surgery (adapted from Harrison 1982): 1. Accurate diagnosis and staging possible, with ex- clusion of associated anomalies 2. Natural history of the disease is documented, and prognosis established The author is Nursing Officer, ESI-PGIMSR, ESI Medical College and Hospital, Joka, Kolkata. Foetal Therapy 6XYDVKUL 6DVPDO 3. Currently no effective postnatal therapy 4. In utero surgery proven, feasible in animal mod- els, reversing deleterious effects of the condition 5. Interventions performed in specialised multidisciplinary foetal treatment centres within strict protocols and approval of the local Ethics Committee with informed consent of the mother or parents. Rationale for in utero therapy for foetal surgery in outlined in Table 1. Types of Foetal Therapy Based on Invasion 1. Non-invasive foetal treatment: foetal pharmaco- therapy: ‘Non-invasive’ here means administering drugs to the mother which reach the foetus via the placenta. This is the mean for administration of cor- ticosteroids, anti-arrhythmics, antiviral and anti- parasitic drugs, propylthiouracil, intravenous admin- istration of immunoglobulin to pregnant women and substitution or restriction diet in inherited foetal metabolic diseases. 2. Minimally invasive foetal treatment via needle inser- tion: Minimally invasive foetal treatment via needle insertion is a phrase used to describe a category of interventions that involve inserting a thin needle (0.7 to 1.1 mm in diameter) into the uterus. These procedures are carried out in an out-patient clinic under local anaesthesia applied to the skin, and usu- ally take 15 to 30 minutes and the whole procedure is done under ultrasonic guidance. These include: Intra-uterine blood transfusion is indicated in red cell alloimmunisation, Parvovirus B19 infection, feto- maternal haemorrhage, twin to twin transfusion syn- drome, chorioangioma, foetal sacro-coccygeal tumour, Kaposi like hemangioendothelioma, homozygous al- pha thalassemia, beta thalassemia, xerocytosis, el- liptocytosis, congenital syphilis, CMV infection, blackfan-diamond anaemia etc. Intra-uterine thrombocyte transfusion indicated in alloimmune thrombocytopenia (FNAIT), Parvovirus B19 infection Direct intravascular foetal anti-arrhythmic admin- istration (via umbilical cord puncture) Minimally invasive foetal therapy via endoscopy (fetoscopy): SEPTEMBER - OCTOBER 2019 VOL. CX NO. 5 195