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American Journal of Obstetrics and... May 1993Our aim was to develop and evaluate a transabdominal endoscopic technique to visualize the embryo or fetus with thin-gauge needles and submillimetric fiberoptic...
OBJECTIVE
Our aim was to develop and evaluate a transabdominal endoscopic technique to visualize the embryo or fetus with thin-gauge needles and submillimetric fiberoptic endoscopes.
METHODS
Under ultrasonographic guidance, an 18- or 19-gauge thin-wall needle was introduced into the uterus of 28 patients undergoing first-trimester or early second-trimester termination of pregnancy. A 0.7 mm endoscope was threaded through the lumen of the needle after removal of the stylet. Visualization of the embryo-fetus was attempted before 14 weeks' gestation (n = 20). From 16 to 20 weeks (n = 8), the needle and endoscope were directed to the placental insertion of the umbilical cord, and a cordocentesis was performed.
RESULTS
Excellent visualization of the surface anatomy of fetuses from 7 to 13 weeks was obtained in 85% of cases (17/20). A diagnosis of Meckel-Gruber syndrome was made at 11 weeks' menstrual age by visualizing postaxial polydactyly and an occipital encephalocele. Endoscopically assisted cordocentesis allowed visualization of the lumen of the umbilical vein and of the blood flow within it.
CONCLUSION
Endoscopic visualization of the embryo or fetus can be performed transabdominally in the first trimester with small-delivered endoscopes. This represents a clear advantage over previous endoscopic approaches to the human pregnancy. Potential applications of this technique include a precise description of fetal anatomy and physiologic features, diagnosis of anomalies, and therapeutic fetal interventions.
Topics: Abdomen; Abnormalities, Multiple; Adult; Encephalocele; Female; Fetal Diseases; Fetoscopes; Fetoscopy; Humans; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Prenatal Diagnosis; Syndrome; Toes
PubMed: 8498442
DOI: 10.1016/s0002-9378(11)90797-2 -
Journal of Perinatal Medicine Jun 2024Fetoscopic laser coagulation of placental anastomoses is usually performed for a treatment of twin-to-twin transfusion syndrome (TTTS). A common complication of... (Comparative Study)
Comparative Study
Fetoscopic laser coagulation for twin-to-twin transfusion syndrome: a comparison of flexible 1.0/1.2 mm fetoscopes with curved sheaths of 2.7/3.3 mm vs. 2 mm fetoscopic lens technique with sheaths of 6.6/11.3 mm.
OBJECTIVES
Fetoscopic laser coagulation of placental anastomoses is usually performed for a treatment of twin-to-twin transfusion syndrome (TTTS). A common complication of fetoscopic laser coagulation for TTTS is preterm preliminary rupture of fetal membranes (PPROM) aggravating the neonatal outcome significantly. However, use of an flexible 1 mm fetoscope with an curved sheath could reduce iatrogenic damage of the amniotic membrane and improve neonatal outcomes after laser treatment. The aim of this study was to compare neonatal outcomes using this flexible fetoscope with curved sheath vs. use of a standard lens technique.
METHODS
Outcomes were retrospective analyzed after use of a standard lens fetoscope of 2 mm (sheath 6.63 mm or 11.27 mm for anterior placenta) and a flexible fetoscope of 1 mm or 1.2 mm (sheath 2.65 mm or 3.34 mm) in two German centers of fetal surgery, performed during 2006-2019.
RESULTS
Neonatal outcome of 247 TTTS patients were analyzed including the rates of double and single fetal survival. The survival of at least one fetus was 97.2 % in the group with the ultrathin technique (n=154) compared to 88.3 % (n=93) in the group with the standard lens fetoscope (p=0.008). Survival of both fetuses was not different between groups (81.0 vs. 75.3 %). The procedure to delivery interval was significantly increased using the ultrathin fetoscope (89.1±35.0 d vs. 71.4±35.4 d, p=0.001) resulting in an increased gestational age at delivery by 11 days on average (231.9±28.1 d vs. 221.1±32.7 d, p=0.012).
CONCLUSIONS
Fetal survival can be significantly increased following TTTS using flexible fetoscope of 1 mm or 1.2 mm (sheath 2.65 mm or 3.34 mm).
Topics: Humans; Fetofetal Transfusion; Pregnancy; Female; Fetoscopy; Retrospective Studies; Laser Coagulation; Fetoscopes; Adult; Infant, Newborn; Fetal Membranes, Premature Rupture
PubMed: 38536953
DOI: 10.1515/jpm-2023-0328 -
Ultrasound in Obstetrics & Gynecology :... Apr 2008To assess outcome after fetoscopic laser coagulation (FLC) of placental vascular anastomoses with the 30 degrees fetoscope in mid-trimester severe twin-to-twin...
OBJECTIVE
To assess outcome after fetoscopic laser coagulation (FLC) of placental vascular anastomoses with the 30 degrees fetoscope in mid-trimester severe twin-to-twin transfusion syndrome (TTTS) with completely anterior placenta compared with the regular 0 degrees fetoscope in TTTS with other placental locations.
METHODS
This was a prospective study of 176 consecutive monochorionic twin pregnancies undergoing FLC for severe TTTS. Of these, 51 patients required use of the 30 degrees fetoscope (study group) and 125 placental locations permitted use of the 0 degrees fetoscope (controls).
RESULTS
The two groups had very similar outcomes. The median gestational age at FLC in the study group vs. control group was 21.0 (range, 17.4-24.6) weeks vs. 20.6 (range, 15.9-24.6) weeks. Both fetuses survived in 58.8% (30/51) of study patients vs. 66.4% (83/125) of controls. At least one fetus survived in 84.3% (43/51) of study patients and 88.8% (111/125) of controls (P = 0.45). Study patients delivered at a median of 34.1 (range, 25.0-38.4) weeks and controls at 34.0 (range, 25.0-40.3) weeks' gestation.
CONCLUSIONS
Use of a 30 degrees fetoscope for FLC in cases of technically challenging extensive anterior placentation is associated with an outcome that is very similar to that achieved when a 0 degrees fetoscope is used in cases of more favorable placental location.
Topics: Adolescent; Adult; Arteriovenous Anastomosis; Case-Control Studies; Chi-Square Distribution; Equipment Design; Female; Fetofetal Transfusion; Fetoscopes; Fetoscopy; Gestational Age; Humans; Laser Coagulation; Placenta; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Second; Prospective Studies; Statistics, Nonparametric; Twins; Ultrasonography, Prenatal
PubMed: 18330890
DOI: 10.1002/uog.5283 -
Ultrasound in Obstetrics & Gynecology :... Jul 1996The ability of ultrasound to diagnose fetal anomalies is limited in the early stages of gestation. We describe a microendoscope that can be used with an 18-gauge needle...
The ability of ultrasound to diagnose fetal anomalies is limited in the early stages of gestation. We describe a microendoscope that can be used with an 18-gauge needle at the time of amniocentesis to provide more precise diagnostic information when the first-trimester ultrasound examination suggests a problem.
Topics: Adult; Amniocentesis; Female; Fetal Diseases; Fetoscopes; Fetoscopy; Fetus; Humans; Pregnancy; Pregnancy Trimester, First; Prenatal Diagnosis; Sensitivity and Specificity; Ultrasonography
PubMed: 8843612
DOI: 10.1046/j.1469-0705.1996.08010011.x -
European Surgical Research. Europaische... 2009The most common complication of intrauterine tracheal balloon occlusion is the preterm premature rupture of membranes (PPROM) which increases the rate of neonatal...
OBJECTIVE
The most common complication of intrauterine tracheal balloon occlusion is the preterm premature rupture of membranes (PPROM) which increases the rate of neonatal morbidity and mortality. Ultrathin fetoscopy may be a method of reducing the risk of PPROM.
MATERIALS AND METHODS
The operation was performed at the 27th week of gestation after sedation and relaxation of a fetus with bilateral congenital diaphragmatic hernia and with the liver lifted upwards into the thorax. An ultrathin sheath with a 1.2-mm fetoscope was used under real-time 3-D ultrasound guidance. The patient delivered in the 38th week of gestation and did not display PPROM after surgery until delivery.
CONCLUSION
Fetal tracheal occlusion using ultrathin fetoscopic equipment in combination with real-time 3-D ultrasound may reduce the risk of PPROM.
Topics: Balloon Occlusion; Female; Fetal Membranes, Premature Rupture; Fetoscopes; Fetoscopy; Gestational Age; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Lung; Monitoring, Intraoperative; Pregnancy; Trachea; Ultrasonography, Prenatal
PubMed: 19521091
DOI: 10.1159/000224146