The value and limitations of using predetermined criteria in decision making for maternal-fetal interventions.

Maternal-fetal interventions – such as prenatal fetal myelomeningocele (MMC) repair – are at the forefront of clinical innovation within maternal-fetal medicine, pediatric surgery, and neonatology. Many centers determine eligibility for innovative procedures using inclusion and exclusion criteria based on seminal studies, such as the “Management of Myelomeningocele Study” for prenatal MMC repair. What if a person’s clinical presentation does not conform to predetermined criteria for maternal-fetal intervention? Does changing criteria on a case-by-case basis (i.e., ad hoc) constitute innovation in practice and flexible personalized care or transgression of commonly held standards with potential negative consequences? We outline a principle-based, bioethically-justified method for answering these questions using fetal MMC repair as an example. We give special attention to the historical origins of inclusion and exclusion criteria; risks and benefits to the pregnant person and the fetus; and team dynamics. This article is protected by copyright. All rights reserved.