Fetal surgery offers window to the womb.(The Master Class)

Until the middle of the 20th century, pregnancy was mired in mystery. The womb existed as a sacred, protected environment that no one dared explore. Physicians awaited the outcome with the sense that "what will be, will be." Eventually the notion developed that evaluation or intervention in the mother would automatically benefit the fetus. Then came crude forms of fetal evaluation, at first just listening to the tone and rhythm of the heart, then tracing the fetal heart rates and evaluating fetal hormones to gain a sense of whether all seemed generally well.

The introduction of ultrasound and fetoscopy represented new frontiers; they provided significantly more precise information about fetal growth and well-being, as well as detection of major congenital malformations and metabolic problems. Maternal-fetal medicine became a more invasive specialty, capable of treating fetal heart rate disturbances with cardiac medication and diverting urine or cerebrospinal fluid by the use of shunts.

Pediatric surgeons, led by Dr. Michael Harrison, his protege Dr. N. Scott Adzick, and their esteemed colleagues at the University of California, San Francisco, took a ...