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December 1989, Vol 143, No. 12 >
Article | December 1989

Fetal Surgery in the 1990s FREE

Mark I. Evans, MD; Arie Drugan, MD; Frank A. Manning, MD; Michael R. Harrison, MD
[+] Author Affiliations

Accepted for publication June 13, 1989.

Reprint requests to Division of Reproductive Genetics, Hutzel Hospital, 4707 St Antoine Blvd, Detroit, MI 48201 (Dr Evans).


Am J Dis Child. 1989;143(12):1431-1436. doi:10.1001/archpedi.1989.02150240053016.
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Comments

In the recent past, the first opportunity to visualize fetal structure and function occurred at birth. Two major contributions in the 1960s inaugurated the era of the fetus as a patient: (1) Prenatal diagnosis became possible using amniocentesis as a technique to evaluate fetal health by cytogenetic1 and biochemical2,3 analysis. (2) Prenatal treatment became possible using fetal transfusion to control rhesus factor erythroblastosis fetalis.4 Intrauterine exchange transfusions through an open abdomen and uterine incision were attempted and abandoned due to unacceptably high maternal morbidity associated with "open" procedures.5 The development of less invasive techniques for percutaneous placement of catheters or needles for intraperitoneal transfusion permitted in utero exchange transfusion.6

In the 1970s, the introduction of fetal ultrasonography allowed for accurate visualization of the structure and function of the fetus.7 As skill and technology advanced, the list of fetal anomalies able to be diagnosed by

REFERENCES

1 +
Steele MW, Breg WR Jr.  Chromosome analysis of human amniotic fluid cells . Lancet . 1966;;1:383-386.
2 +
Nadler HL.  Antenatal detection of hereditary disorders . Pediatrics . 1968;;42:912-915.
3 +
Nadler HL, Gerbie AB.  Role of amniocentesis in the intrauterine detection of genetic disorders . N Engl J Med . 1970;;282:596-598.
4 +
Liley AW.  Intrauterine transfusion of foetus inhaemolyticdisease . Br Med J . 1963;;2:1107-1109.
5 +
Freda VJ, Adamson K Jr.  Exchange transfusion in utero: report of a case . Am J Obstet Gynecol . 1964;;89:817-821.
6 +
Liggins GC.  Fetal transfusion by the impaling technique . Obstet Gynecol . 1966;;27:323-326.
7 +
Campbell S, Johnstone FD, Holt EM, et al.  Anencephaly: early ultrasonic diagnosis and active management . Lancet . 1972;;2:1226.
8 +
Nicolaides KH, Campbell S.  Diagnosis of fetal abnormalities by ultrasound . In: Milunsky A, ed. Genetic Disorders and the Fetus . 2nd ed. New York, NY: Plenum Publishing Corp; 1986;:521-570.
9 +
Evans MI, Belsky RL, Greb A, Clemintino N, Sywen FN.  Alpha-fetoprotein: maternal serum and amniotic fluid analysis . In: Evans MI, Fletcher JC, Dixler AO, Schulman JD. Fetal Diagnosis and Therapy: Science, Ethics and the Law . Philadelphia, Pa: JB Lippincott; 1989;:44-54.
10 +
Stewart PA, Wladimiroff JW.  Cardiac tachyarrhythmia in the fetus: diagnosis treatment and prognosis . Fetal Therap . 1987;;2:7-16.
11 +
Evans MI, Schulman JD. Medical fetal therapy . In: Evans MI, Fletcher JC, Dixler AO, Schulman JD. Fetal Diagnosis and Therapy: Science, Ethics and the Law . Philadelphia, Pa: JB Lippincott; 1989;:403-412.
12 +
Drugan A, Miller OJ, Evans MI. Gene therapy. Fetal Therap. In press.
13 +
Harrison MR, Golbus MS, Filly RA.  Management of the fetus with a correctable congenital defect . JAMA . 1981;;246:774-777.
14 +
Harrison MR, Filly RA, Parer JT, Faer MJ, Jacobson JB, Delorimier AA.  Management of the fetus with a urinary tract malformation . JAMA . 1981;;246:635-639.
15 +
Harrison MR, Filly RA, Golbus MS, et al.  Fetal treatment 1982 . N Engl J Med . 1982;;307: 1651-1652.
16 +
Manning FA, Harrison MR, Rodeck C.  Catheter shunts for fetal hydronephrosis and hydrocephalus . N Engl J Med . 1986;;315:336-340.
17 +
McCullough DC, Balzer Martin CA.  Current prognosis in overt neonatal hydrocephalus . J Neurosurg . 1982;;57:378-383.
18 +
Harrison MR.  Congenital hydrocephalus . In: Harrison MR, Golbus MS, Filly RA, eds. The Unborn Patient . New York, NY: Grune & Stratton; 1984;:349-377.
19 +
Glick PL, Harrison MR, Hauss-Miller M.  Correction of congenital hydrocephalus in utero, II: efficacy of 'in utero' shunting . J Pediatr Surg . 1984;;19:870-875.
20 +
Michejda M, Hodgen GD.  In utero diagnosis and treatment of nonhuman fetal skeletal anomalies, I: hydrocephalus . JAMA . 1981;;246:1093-1097.
21 +
Bovicelli L.  Management of pregnancies complicated by fetal central nervous system abnormalities . Fetal Therap . 1986;;1:80-82.
22 +
Clewell WL, Manco-Johnson ML, Manchester DK.  Diagnosis and management of fetal hydrocephalus . Clin Obstet Gynecol . 1986;;29:514-522.
23 +
Hudjins RJ, Edwards MSB, Goldstein R, et al.  Natural History of fetal ventriculomegaly . Pediatrics 1988;;82:692-697.
24 +
Drugan A, Krause B, Canady A, Zador IE, Sacks AJ, Evans MI.  The natural history of prenatally diagnosed ventriculomegaly . JAMA . 1989;; 261:1785-1788.
25 +
Drugan A, Zador IE, Bhatia RK, Sacks AJ, Evans MI. First trimester diagnosis and early in utero treatment of obstructive uropathy. Acta Obstet Gynecol Scand. In press.
26 +
Harrison MR, Ross NA, Naoll R, deLorimier AA.  Correction of congenital hydronephrosis in utero, I: the model: fetal urethral obstruction produces hydronephrosis and pulmonary hypoplasia in fetal lambs . J Pediatr Surg . 1983;;18:247-256.
27 +
Harrison MR, Nakayama DK, Noall R, Ross NA, Delorimier AA.  Correction of congenital hydronephrosis in utero, II: decompression reverses the effects of obstruction on the fetal lung and urinary tract . J Pediatr Surg . 1982;;17:965-974.
28 +
Glick PL, Harrison MR, Noall RA, Villa RL.  Correction of congenital hydronephrosis in utero, III: early mid-trimester ureteral obstruction produces renal dysplasia . J Pediatr Surg . 1983;;18:681-687.
29 +
Glick PL, Harrison MR, Adzick NS, Noall RA, Villa RL.  Correction of congenital hydronephrosis in utero, IV: in utero ureteral decompression prevents renal dysplasia . J Pediatr Surg . 1984;;19:649-657.
30 +
Adzick NS, Harrison MR, Glick PL, Flake AW.  Fetal urinary tract obstruction: experimental pathophysiology . Semin Perinatol . 1985;;9:79-90.
31 +
Weiner C, Williamson R, Monsib MS, et al.  In utero bladder diversion problems with patients selection . Fetal Therap . 1986;;1:196-202.
32 +
Seeds WJ, Mittelstaedt AC, Mandell J.  Preand postnatal ultrasonographic diagnosis of congenital obstructive uropathies . Urol Clin North Am . 1986;;13:131-154.
33 +
Quinlan WR, Cruz AC, Huddleston JF.  Sonographic detection of fetal urinary tract anomalies . Obstet Gynecol . 1986;;67:558-565.
34 +
Gembruch U, Hansmann M.  Artificial instillation of amniotic fluid as a new technique for the diagnostic evaluation of cases of oligohydramnios . Prenat Diagn . 1988;;8:33-45.
35 +
Bond SJ, Harrison MR.  Obstructive uropathy: when to intervene . Contemp Obstet Gynecol . 1987;;(special (issue) ):64-74.
36 +
Golbus MS, Filly RA, Callen PW, et al.  Fetal urinary tract obstruction: management and selection of treatment . Semin Perinatol . 1985;;9:91-97.
37 +
Wilkins IA, Chitkara U, Lynch L, Goldberg JD, Mehalek KE, Berkowitz RL.  The non-predictive value of fetal urinary electrolytes: preliminary report of outcomes and correlation with pathologic diagnosis . Am J Obstet Gynecol . 1987;;157:694-698.
38 +
Dumez Y, Revillon Y, Dommergues M, et al. Long-term predictive value of fetal renal function. Presented at the Fifth Meeting of the International Fetal Medicine and Surgery Society; June 10, 1988; Bonn, West Germany.
39 +
Harrison MR, Golbus MS, Filly RA, et al.  Management of the fetus with congenital hydronephrosis . J Pediatr Surg . 1982;;17:728-742.
40 +
Glick PL, Harrison MR, Adzick NS, et al.  Management of the fetus with congenital hydronephrosis, II: prognostic criteria and selection for treatment . J Pediatr Surg . 1985;;20:376-387.
41 +
Crombleholme TM, Harrison MR, Langer JC, Longaker MG, Anderson RL, Slotnick NS.  Early experience with open fetal surgery for congenital hydronephrosis . J Pediatr Surg . 1988;;23:1114-1121.
42 +
Asensio SH, Figueroa-Longo JG, Pelegrina IA.  Intrauterine exchange transfusion: a new technique . Obstet Gynecol . 1968;;32:350-355.
43 +
Nakayama DK, Harrison MR, Chinn DH, et al.  Prenatal diagnosis and natural history of the fetus with congenital diaphragmatic hernia: initial clinical experience . J Pediatr Surg . 1985;;20:118-124.
44 +
Adzick NS, Harrison MR, Glick PL, Nakayama DK, Manning FA, Delorimier AA.  Diaphragmatic hernia in the fetus: prenatal diagnosis and outcome in 94 cases . J Pediatr Surg . 1985;;20:357-361.
45 +
Adzick NS, Vacanti JP, Lillehei CW, O'Rourke PP, Crone RK, Wilson JM.  Fetal diaphragmatic hernia: ultrasound diagnosis and clinical outcome in 38 cases from a single medical center . J Pediatr Surg . 1989;;24:654-658.
46 +
Harrison MR, Adzick NS, Nakayama DK, deLorimier AA.  Fetal diaphragmatic hernia: pathophysiology, natural history and outcome . Clin Obstet Gynecol . 1986;;29:490-501.
47 +
Harrison MR, Jester JA, Ross NA.  Correction of congenital diaphragmatic hernia in utero, I: the model: intrathoracic balloon produces fatal pulmonary hypoplasia . Surgery . 1980;;88:174-182.
48 +
Harrison MR, Bressack MA, Chung AM, Delorimier AA.  Correction of congenital diaphragmatic hernia in utero, II: simulated correction permits fetal lung growth with survival at birth . Surgery . 1980;;88:260-268.
49 +
Harrison MR, Anderson J, Rosen MA, Ross NA, Hendrickx AF.  Fetal surgery in the primate, I: anesthetic, surgical and tocolytic management to maximize fetal-neonatal survival . J Pediatr Surg . 1982;;17:115-122.
50 +
Nakayama DK, Harrison MR, Seron-Ferre M, Villa RL.  Fetal surgery in the primate, II: uterine electromyographic response to operative procedures and pharmacologic agents . J Pediatr Surg . 1984;;19:333-339.
51 +
Adzick NS, Harrison MR, Glick PL, Anderson JV, Flake AW, Villa RL.  Fetal surgery in the primate, III: maternal outcome after fetal surgery . J Pediatr Surg . 1986;;21:477-480.
52 +
Crombleholme TM, Harrison MR, Langer JC, et al.  Early experience with open fetal surgery for congenital hydrocephrosis . J Pediatr Surg . 1988;;23:1114-1121.
53 +
Harrison MR, Langer JC, Adzick NS, et al. Correction of congenital diaphragmatic hernia in utero, V: initial clinical experience. J Pediatr Surg. In press.
54 +
Langer JC, Harrison MR, Schmidt KG, et al.  Fetal hydrops and death from sacrococcygeal teratoma: rationale for fetal surgery . Am J Obstet Gynecol . 1989;;160:1145-1150.
55 +
Pringle KC.  Fetal surgery: it has a past, has it a future? Fetal Therap . 1986;;1:23-31.
56 +
Harman CR.  Bioethical issues in perinatology: is the future now? Fetal Therap . 1986;;1:217-222.
57 +
Lehmann DK, Mabie WC, Miller JM, Pernoll MI.  The epidemiology and pathology of maternal mortality: Charity Hospital of Louisiana in New Orleans, 1965-1984 . Obstet Gynecol . 1987;;69:833-839.
58 +
Cochrane D, Coupland S. The feasibility of evoked potential monitoring in a fetal lamb model: an electro-physiological parameter of brain development. Presented at the Fifth Meeting of International Fetal Medicine and Surgery Society; June 10, 1988; Bonn, West Germany.

Figures

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Steele MW, Breg WR Jr.  Chromosome analysis of human amniotic fluid cells . Lancet . 1966;;1:383-386.
2 +
Nadler HL.  Antenatal detection of hereditary disorders . Pediatrics . 1968;;42:912-915.
3 +
Nadler HL, Gerbie AB.  Role of amniocentesis in the intrauterine detection of genetic disorders . N Engl J Med . 1970;;282:596-598.
4 +
Liley AW.  Intrauterine transfusion of foetus inhaemolyticdisease . Br Med J . 1963;;2:1107-1109.
5 +
Freda VJ, Adamson K Jr.  Exchange transfusion in utero: report of a case . Am J Obstet Gynecol . 1964;;89:817-821.
6 +
Liggins GC.  Fetal transfusion by the impaling technique . Obstet Gynecol . 1966;;27:323-326.
7 +
Campbell S, Johnstone FD, Holt EM, et al.  Anencephaly: early ultrasonic diagnosis and active management . Lancet . 1972;;2:1226.
8 +
Nicolaides KH, Campbell S.  Diagnosis of fetal abnormalities by ultrasound . In: Milunsky A, ed. Genetic Disorders and the Fetus . 2nd ed. New York, NY: Plenum Publishing Corp; 1986;:521-570.
9 +
Evans MI, Belsky RL, Greb A, Clemintino N, Sywen FN.  Alpha-fetoprotein: maternal serum and amniotic fluid analysis . In: Evans MI, Fletcher JC, Dixler AO, Schulman JD. Fetal Diagnosis and Therapy: Science, Ethics and the Law . Philadelphia, Pa: JB Lippincott; 1989;:44-54.
10 +
Stewart PA, Wladimiroff JW.  Cardiac tachyarrhythmia in the fetus: diagnosis treatment and prognosis . Fetal Therap . 1987;;2:7-16.
11 +
Evans MI, Schulman JD. Medical fetal therapy . In: Evans MI, Fletcher JC, Dixler AO, Schulman JD. Fetal Diagnosis and Therapy: Science, Ethics and the Law . Philadelphia, Pa: JB Lippincott; 1989;:403-412.
12 +
Drugan A, Miller OJ, Evans MI. Gene therapy. Fetal Therap. In press.
13 +
Harrison MR, Golbus MS, Filly RA.  Management of the fetus with a correctable congenital defect . JAMA . 1981;;246:774-777.
14 +
Harrison MR, Filly RA, Parer JT, Faer MJ, Jacobson JB, Delorimier AA.  Management of the fetus with a urinary tract malformation . JAMA . 1981;;246:635-639.
15 +
Harrison MR, Filly RA, Golbus MS, et al.  Fetal treatment 1982 . N Engl J Med . 1982;;307: 1651-1652.
16 +
Manning FA, Harrison MR, Rodeck C.  Catheter shunts for fetal hydronephrosis and hydrocephalus . N Engl J Med . 1986;;315:336-340.
17 +
McCullough DC, Balzer Martin CA.  Current prognosis in overt neonatal hydrocephalus . J Neurosurg . 1982;;57:378-383.
18 +
Harrison MR.  Congenital hydrocephalus . In: Harrison MR, Golbus MS, Filly RA, eds. The Unborn Patient . New York, NY: Grune & Stratton; 1984;:349-377.
19 +
Glick PL, Harrison MR, Hauss-Miller M.  Correction of congenital hydrocephalus in utero, II: efficacy of 'in utero' shunting . J Pediatr Surg . 1984;;19:870-875.
20 +
Michejda M, Hodgen GD.  In utero diagnosis and treatment of nonhuman fetal skeletal anomalies, I: hydrocephalus . JAMA . 1981;;246:1093-1097.
21 +
Bovicelli L.  Management of pregnancies complicated by fetal central nervous system abnormalities . Fetal Therap . 1986;;1:80-82.
22 +
Clewell WL, Manco-Johnson ML, Manchester DK.  Diagnosis and management of fetal hydrocephalus . Clin Obstet Gynecol . 1986;;29:514-522.
23 +
Hudjins RJ, Edwards MSB, Goldstein R, et al.  Natural History of fetal ventriculomegaly . Pediatrics 1988;;82:692-697.
24 +
Drugan A, Krause B, Canady A, Zador IE, Sacks AJ, Evans MI.  The natural history of prenatally diagnosed ventriculomegaly . JAMA . 1989;; 261:1785-1788.
25 +
Drugan A, Zador IE, Bhatia RK, Sacks AJ, Evans MI. First trimester diagnosis and early in utero treatment of obstructive uropathy. Acta Obstet Gynecol Scand. In press.
26 +
Harrison MR, Ross NA, Naoll R, deLorimier AA.  Correction of congenital hydronephrosis in utero, I: the model: fetal urethral obstruction produces hydronephrosis and pulmonary hypoplasia in fetal lambs . J Pediatr Surg . 1983;;18:247-256.
27 +
Harrison MR, Nakayama DK, Noall R, Ross NA, Delorimier AA.  Correction of congenital hydronephrosis in utero, II: decompression reverses the effects of obstruction on the fetal lung and urinary tract . J Pediatr Surg . 1982;;17:965-974.
28 +
Glick PL, Harrison MR, Noall RA, Villa RL.  Correction of congenital hydronephrosis in utero, III: early mid-trimester ureteral obstruction produces renal dysplasia . J Pediatr Surg . 1983;;18:681-687.
29 +
Glick PL, Harrison MR, Adzick NS, Noall RA, Villa RL.  Correction of congenital hydronephrosis in utero, IV: in utero ureteral decompression prevents renal dysplasia . J Pediatr Surg . 1984;;19:649-657.
30 +
Adzick NS, Harrison MR, Glick PL, Flake AW.  Fetal urinary tract obstruction: experimental pathophysiology . Semin Perinatol . 1985;;9:79-90.
31 +
Weiner C, Williamson R, Monsib MS, et al.  In utero bladder diversion problems with patients selection . Fetal Therap . 1986;;1:196-202.
32 +
Seeds WJ, Mittelstaedt AC, Mandell J.  Preand postnatal ultrasonographic diagnosis of congenital obstructive uropathies . Urol Clin North Am . 1986;;13:131-154.
33 +
Quinlan WR, Cruz AC, Huddleston JF.  Sonographic detection of fetal urinary tract anomalies . Obstet Gynecol . 1986;;67:558-565.
34 +
Gembruch U, Hansmann M.  Artificial instillation of amniotic fluid as a new technique for the diagnostic evaluation of cases of oligohydramnios . Prenat Diagn . 1988;;8:33-45.
35 +
Bond SJ, Harrison MR.  Obstructive uropathy: when to intervene . Contemp Obstet Gynecol . 1987;;(special (issue) ):64-74.
36 +
Golbus MS, Filly RA, Callen PW, et al.  Fetal urinary tract obstruction: management and selection of treatment . Semin Perinatol . 1985;;9:91-97.
37 +
Wilkins IA, Chitkara U, Lynch L, Goldberg JD, Mehalek KE, Berkowitz RL.  The non-predictive value of fetal urinary electrolytes: preliminary report of outcomes and correlation with pathologic diagnosis . Am J Obstet Gynecol . 1987;;157:694-698.
38 +
Dumez Y, Revillon Y, Dommergues M, et al. Long-term predictive value of fetal renal function. Presented at the Fifth Meeting of the International Fetal Medicine and Surgery Society; June 10, 1988; Bonn, West Germany.
39 +
Harrison MR, Golbus MS, Filly RA, et al.  Management of the fetus with congenital hydronephrosis . J Pediatr Surg . 1982;;17:728-742.
40 +
Glick PL, Harrison MR, Adzick NS, et al.  Management of the fetus with congenital hydronephrosis, II: prognostic criteria and selection for treatment . J Pediatr Surg . 1985;;20:376-387.
41 +
Crombleholme TM, Harrison MR, Langer JC, Longaker MG, Anderson RL, Slotnick NS.  Early experience with open fetal surgery for congenital hydronephrosis . J Pediatr Surg . 1988;;23:1114-1121.
42 +
Asensio SH, Figueroa-Longo JG, Pelegrina IA.  Intrauterine exchange transfusion: a new technique . Obstet Gynecol . 1968;;32:350-355.
43 +
Nakayama DK, Harrison MR, Chinn DH, et al.  Prenatal diagnosis and natural history of the fetus with congenital diaphragmatic hernia: initial clinical experience . J Pediatr Surg . 1985;;20:118-124.
44 +
Adzick NS, Harrison MR, Glick PL, Nakayama DK, Manning FA, Delorimier AA.  Diaphragmatic hernia in the fetus: prenatal diagnosis and outcome in 94 cases . J Pediatr Surg . 1985;;20:357-361.
45 +
Adzick NS, Vacanti JP, Lillehei CW, O'Rourke PP, Crone RK, Wilson JM.  Fetal diaphragmatic hernia: ultrasound diagnosis and clinical outcome in 38 cases from a single medical center . J Pediatr Surg . 1989;;24:654-658.
46 +
Harrison MR, Adzick NS, Nakayama DK, deLorimier AA.  Fetal diaphragmatic hernia: pathophysiology, natural history and outcome . Clin Obstet Gynecol . 1986;;29:490-501.
47 +
Harrison MR, Jester JA, Ross NA.  Correction of congenital diaphragmatic hernia in utero, I: the model: intrathoracic balloon produces fatal pulmonary hypoplasia . Surgery . 1980;;88:174-182.
48 +
Harrison MR, Bressack MA, Chung AM, Delorimier AA.  Correction of congenital diaphragmatic hernia in utero, II: simulated correction permits fetal lung growth with survival at birth . Surgery . 1980;;88:260-268.
49 +
Harrison MR, Anderson J, Rosen MA, Ross NA, Hendrickx AF.  Fetal surgery in the primate, I: anesthetic, surgical and tocolytic management to maximize fetal-neonatal survival . J Pediatr Surg . 1982;;17:115-122.
50 +
Nakayama DK, Harrison MR, Seron-Ferre M, Villa RL.  Fetal surgery in the primate, II: uterine electromyographic response to operative procedures and pharmacologic agents . J Pediatr Surg . 1984;;19:333-339.
51 +
Adzick NS, Harrison MR, Glick PL, Anderson JV, Flake AW, Villa RL.  Fetal surgery in the primate, III: maternal outcome after fetal surgery . J Pediatr Surg . 1986;;21:477-480.
52 +
Crombleholme TM, Harrison MR, Langer JC, et al.  Early experience with open fetal surgery for congenital hydrocephrosis . J Pediatr Surg . 1988;;23:1114-1121.
53 +
Harrison MR, Langer JC, Adzick NS, et al. Correction of congenital diaphragmatic hernia in utero, V: initial clinical experience. J Pediatr Surg. In press.
54 +
Langer JC, Harrison MR, Schmidt KG, et al.  Fetal hydrops and death from sacrococcygeal teratoma: rationale for fetal surgery . Am J Obstet Gynecol . 1989;;160:1145-1150.
55 +
Pringle KC.  Fetal surgery: it has a past, has it a future? Fetal Therap . 1986;;1:23-31.
56 +
Harman CR.  Bioethical issues in perinatology: is the future now? Fetal Therap . 1986;;1:217-222.
57 +
Lehmann DK, Mabie WC, Miller JM, Pernoll MI.  The epidemiology and pathology of maternal mortality: Charity Hospital of Louisiana in New Orleans, 1965-1984 . Obstet Gynecol . 1987;;69:833-839.
58 +
Cochrane D, Coupland S. The feasibility of evoked potential monitoring in a fetal lamb model: an electro-physiological parameter of brain development. Presented at the Fifth Meeting of International Fetal Medicine and Surgery Society; June 10, 1988; Bonn, West Germany.

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