EP10.25: Initiation of fetal therapy at Semmelweis University, Hungary

This study presents our improvements in setting up a Fetal Medicine Task Force at the Semmelweis University, Obstetrics and Gynecology Department in December 2023. The aim of the work group is to reduce adverse outcome of pregnancies by reviewing and updating national guidelines of managing high-risk pregnancies, set up a referral system for patients with fetal abnormalities and plan their care, and identify candidates for fetal therapy. Fetal therapy is known to be lifesaving for fetuses with conditions that can be lethal in utero, but treated after birth. Hungary is a small country with almost 10 million inhabitants, therefore the number of cases are small. In the country we have around 80-90 thousand birth a year and as being the central referral University Hospital with a National Genetic Center we see a decent amount of cases that are candidates for fetal therapy. We set up a multidisciplinary task force of specialists in Obstetrics and Gynecology, Fetal Medicine, Clinical Genetics, Perinatal Pathology and consulting frequently with Neonatologists. During the first 3 months we performed 7 uncomplicated intrauterine fetal transfusions (4 times approaching the intrahepatic portion of the umbilical vein in intramuscular fetal anesthesia and 3 times the fetal umbilical vein at the origin of the placenta). Furthermore, we successfully performed relieving cystocentesis in a case of a fetus with megacystis, for whom we plan to insert vesicoamniotic shunt. During this period our task force made a groundbreaking step in the field of Fetal Medicine in Hungary and successfully performed 8 interventions, that improved perinatal outcome. In an ongoing case of a fetus with isolated bilateral pleural effusion, following diagnostic amniocentesis we are planning the insertion of fetal thoracoamniotic shunt. More interventions and long-term follow-up are planned to improve substantially perinatal mortality and morbidity in Hungary.