Evolution and Prospects of Educational Pathways in Invasive Prenatal Procedures

Abstract

Invasive prenatal procedures (IPPs) are integral to the practice of perinatology. The most commonly performed diagnostic procedures include chorionic villus sampling, amniocentesis, and percutaneous umbilical blood sampling. These techniques require precise hand–eye coordination under real-time ultrasonographic guidance. Fetal therapeutic procedures demand even more advanced skills, combining real-time ultrasound guidance with endoscopic surgical techniques. Structured training is essential to minimize procedure-related complications, particularly among less experienced operators. Teaching methods generally include simulation, animal models, mentorship–apprenticeship, and curriculum-based workshops. Simulation-based training employs both low-fidelity box trainers and high-fidelity virtual reality systems. Animal model training offers several advantages over ex-vivo synthetic simulators. Pregnant sheep provide the most realistic model for training and for developing novel in-utero surgical techniques because of their suitable uterine volume and fetal size. However, the cost and ethical concerns remain major limitations. Mentorship–apprenticeship typically begins with observation, followed by hands-on training and progressive responsibility until independent performance. Hands-on workshops offer opportunities to refresh skills in infrequently performed procedures. The advent of non-invasive prenatal testing using cell-free fetal DNA analysis has significantly reduced the number of invasive diagnostic procedures. Consequently, training programs must adapt to these changing circumstances. This article aims to assess current training paradigms, identify existing gaps, and propose future directions for skill acquisition in IPPs.