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At least 19 recordsLinked to original sources
PubMed1992

Fetoscopic surgery for the treatment of congenital anomalies.

Fetoscopic techniques may broaden the indications for prenatal surgical intervention by obviating the risks of hysterotomy. For example, congenital obstructive uropathy has been treated by open vesicostomy and percutaneous catheter placement. The open approach is appropriate only for highly selected fetuses because of the inherent risks, whereas catheter drainage, though a safer procedure, is only useful for short-term therapy late in gestation due to frequent catheter obstruction and migration. The natural history of congenital obstructive uropathy mandates the need for improved therapy earlier in gestation, in order to salvage fetuses who would otherwise die of renal failure and pulmonary hypoplasia. We have developed a potential solution to this problem in which surgery is performed on the fetus without the risks of hysterotomy. Endoscopic fetal surgery uses a telescopic lens and operating instruments that are passed through small "ports" in the uterus. A bubble of CO2 is used to displace amniotic fluid and provides excellent visualization in a magnified field. This approach is considerably less invasive than open fetal surgery and, therefore, is less likely to provoke preterm labor. In this study we corrected obstructive uropathy in midgestation fetal lambs using a new, expandable wire mesh stent that is placed endoscopically and should provide more reliable bladder drainage than existing catheters. The fetoscopic surgical approach can potentially expand the indications for in utero surgery by decreasing fetal risks, facilitating intervention earlier in gestation, and reducing preterm labor. As a consequence, the potential now exists to correct non-life-threatening malformations in utero.

Animals↗
PubMed1990

Fetoscopic neodymium:YAG laser occlusion of placental vessels in severe twin-twin transfusion syndrome.

Most pregnancies with severe twin-twin transfusion syndrome before 27 weeks' gestation result in perinatal death. Previous attempts at therapy have been generally unsatisfactory and rarely successful. We have developed a technique for intrauterine ablation of the vascular communications between the fetoplacental circulations with a fetoscopically directed neodymium:YAG laser. The operation was performed on three women at risk for pregnancy loss from acute hydramnios at 18.5, 22, and 22.5 weeks' gestation. The first two procedures were uneventful, but the third was complicated by a placental vessel perforation. The first two patients delivered at 27 and 34 weeks after premature rupture of membranes and spontaneous labor, whereas the third woman developed severe preeclampsia at 29 weeks which necessitated delivery. Four of the six infants survived. Clinical and ultrasonographic evidence, as well as pathologic examination of the placentas, suggested that stabilization or resolution of the syndrome was due to photocoagulation of the vascular communications. This initial experience suggests that fetoscopic laser occlusion of placental vessels is feasible and superior to previous therapies because it treats the underlying pathophysiology directly.

Adult↗
PubMed1990

[Prenatal diagnosis of Duchenne muscular dystrophy by fetoscopic muscle biopsy. Report of a case].

A needle muscle biopsy through a fetoscope for the antenatal diagnosis of Duchenne muscular dystrophy (DMD) was reported the mother was a carrier of 30 years old with a family history of Duchenne muscular dystrophy. Her brother died of DMD and her son had suffering from DMD. At 17 weeks of her second gestation, an amniotic puncture was performed. The cellular chromosome was found to be a male fetus (46,xy). At 20 weeks of her gestation, a needle muscle biopsy of the male fetus was performed under fetoscopy and turned out to be Duchenne muscular dystrophy. At 23 weeks, a male fetus was born with induced labor. The pre and postnatal muscles were examined under the light and electron--microscopes. The large hyaline round fibres were positive for calcium. There was evidence of a break down of the basement membranes, appearance of A and I bands and fragmentation of Z bands. Myofibrils were replaced by thin filaments. The diagnosis of Duchenne muscular dystrophy was established on the basic of these findings. This was considered the first case of antenatal fetal Duchenne muscular dystrophy diagnosed with the aid of fetoscope and needle muscle biopsy.

Abortion, Induced↗
PubMed1975

The "fetoscope"--a new clinical tool for prenatal genetic diagnosis.

Our experience in 65 patients using a "fetoscope" and local anesthesia prior to saline abortion is described. Visualization of the intrauterine contents improved with experience, was optimum at 16 to 18 weeks' gestation, and was superior to the quality of photographic records. Four fetal skin biopsies and 6 amnion biopsies were done. Six blood samples were taken from the fetal surface of the placenta. The limitations of this instrument are described. No significant complications have occurred. Current and probable future indications for fetoscopy are reviewed. Until both the safety of the procedure is proved and problems of visualization due to limitation of visual field are solved, extreme caution is urged in the employment of this instrument in genetic high-risk pregnancy.

Abortion, Therapeutic↗
PubMed1988

A fetoscopic method for enucleation in developmental studies of the visual system.

Prenatal enucleation is accomplished by fetoscopy using an arthroscope and a needle for the delivery of electric current into the uterus of anesthetized, pregnant cats. Under direct vision, the eye(s) of the fetus are easily discerned and can readily be lesioned by the application of an electrical current delivered through the needle. The procedure is relatively simple to perform, minimizes uterine trauma and therefore postsurgical recovery times for the mother cat, enhances the prolongation of pregnancy and allows a shorter operating time for accomplishing the enucleation than does normal surgical invasion. It should be possible to make other uses of the approach, such as prenatal ocular injection of dyes or of tracer substances in place of the enucleation.

Animals↗
PubMed1987

[Results of fetoscopic examinations at our hospital].

From 1983 to 1985, antenatal diagnosis by fetoscopy under ultrasound guidance has been performed at our institute for 17 pregnant women between 15 and 34 weeks of gestation. Indications for fetoscopy were visualization of the fetus, placenta, and amniotic membrane for morphological anomaly and fetal blood sampling for coagulation disorder. The diagnosis, made by visual observation of the fetus, blood coagulation tests, and karyotyping revealed 12 normal fetuses and 5 abnormal fetuses (one having chromosome abnormality, one amniotic band syndrome, one cephalothracopagus, one Beckwith-Wiedemann syndrome, and one sacral tumor). Courses of pregnancy following fetoscopy resulted in four normal full-term deliveries, six premature deliveries due to four hydramnions and two spontaneous ruptures of the membrane more than 14 weeks after fetoscopy. Three other pregnancies were interrupted due to intrauterine fetal death 11 weeks after fetoscopy in one case and to therapeutic abortion for maternal complications such as toxemia of pregnancy in two cases. The outcome of one case was unknown because the mother had moved away. The other pregnancy is still under observation at the third trimester. Although no complications in the fetuses were seen following fetoscopy, complications in the mothers included two cases of genital bleeding, one case of amniotic fluid leakage, and one cases of abruption of the fetal membrane. Symptoms in all four cases disappeared during several days of bed rest. These results demonstrate the importance of fetoscopy in prenatal diagnosis.

Amniotic Band Syndrome↗
PubMed1977

[Clinical experience with fetoscopy (author's transl)].

A fetoscope with a trocar of an external diameter of 3.9 and internal diameter of 2.9 mm was used. The optical equipment of the fetoscope had lenses with external diameters of 2.2 and 2.7 mm. The fetoscope can be inserted into the uterine cavity through the abdominal wall with local anaesthesia and insertion controlled by ultrasound. This type of insertion is uncomplicated and relatively free of risks. Thus an essential prerequisite for a successful fetoscopy is fulfilled. For the success of the fetoscopy, it is important to know what the diagnostic value of the procedure is and what can be seen through the fetoscope. The direct intrauterine visualization of the fetus or parts of the fetus is with the fetoscope under evaluation possible and was successful in 23 of 26 fetuses. The field of visualization is limited to 50 degrees by the optical system and only small parts of the fetus can be seen at a time. The extent of visualization of the fetus depends besides the optical system, on the quality of the amniotic fluid and the optimal timing of the fetoscopy in the second trimester between 15 and 18 weeks. Success is also dependant on the endoscopic experience and the technical training of the observer. After 13 of 26 fetoscopies the improvement was approximately 70%. Inspection of some parts of the fetus, for intance, the face is successful in every detail but still more or less fortuitous. Fetoscopy can only be deemed to be successful when a more or less total visualization of the fetus has heen accomplished. This was the case in 39% of the cases. Fetoscopy was used for diagnostic purpose in one case with the term delivery of a healthy infant. Fetal blood sampling by puncture of placental vessels under visualization is in its infancy. Fetoscopy is a justified procedure at this time in cases with a high genetic risk and for the avoidance of an abruptio.

Amniotic Fluid↗
PubMed1979

Fetoscopy--a new endoscopic approach.

A total of 105 fetoscopies were performed either prior to therapeutic abortions or, in 29 cases, for diagnostic purposes. In these latter cases the fetuses were at increased risk for congenital syndromes, limb deformities, cleft lip and palate or neural-tube defects. The procedure is performed transabdominally under local anaesthesia. The studies confirmed the practicability of the fetoscopic technique as described. Done under direct vision, using simultaneous real-time ultrasound-scanning, the fetoscope can be introduced without damage to fetus and placenta. In diagnostic cases, a total visualization of the entire fetus is not always necessary, as recognition and examination of specific fetal parts is often sufficient for prenatal diagnosis. Viewed in this way, the rate of diagnostic fetoscopies reached 78%. In these cases, the targets chosen for inspection could, in fact, be reached by the fetoscope. A total inspection of the fetus was aimed at in those fetoscopies performed prior to planned abortions in order to gain practice, and this was achieved in 42% of cases. In 5 of the 29 patients already mentioned, the pregnancy was terminated immediately after fetoscopy, and in 24 cases pregnancy was continued. Abortions have so far been recorded in 4 cases, not all of which were necessarily due to the fetoscopy, however. In general, fetoscopy appears to hold less danger for mother and child than had previously been anticipated.

Abortion, Therapeutic↗
PubMed1989

Neodymium:yttrium-aluminum-garnet laser occlusion of rhesus placental vasculature via fetoscopy.

We tested the feasibility of photocoagulating placental vascular communications with a fetoscopically delivered neodymium:yttrium-aluminum-garnet laser in 12 pregnant monkeys in the second trimester. The technique was successful in eight cases. One ended in spontaneous labor 2 weeks after occlusion and one stillbirth occurred at term. Six live fetuses were delivered at term, with all treated vessels demonstrating occlusion. There was minimal placental damage at the laser impact sites, and no fetal abnormalities were detected. Long-term occlusion of placental vasculature can be accomplished by fetoscopically delivered laser energy.

Animals↗
PubMed1977

[Fetoscopy under ultrasound control (author's transl)].

Under local anaesthesia and ultrasound control (beta-mode; Vidoson) the fetoscope was introduced into the amniotic cavity in 23 women, 13-20 weeks pregnant. Used before planned surgical abortion the method decisively reduced the dangers of damage to the fetus. In 21 women introduction of the fetoscope was without problem, but twice obesity made it difficult. Placental surface, umbilical cord, fetal head and fetal limbs were more commonly seen than other fetal parts. In one instance fetoscopy made it possible to exclude Mohr's syndrome. Preliminary attempts to obtain fetal blood by puncture of placental vessels under fetoscopy were successful. The described technique seems highly promising. Further experience will demonstrate whether it is without danger and simple enough to be used routinely in the prenatal diagnosis of congenital anomalies.

Anesthesia, Local↗
PubMed1985

Fetoscopy in the assessment of unexplained fetal hydrops.

Pure fetal blood samples, obtained fetoscopically from 30 patients with unexplained fetal hydrops at 16 to 32 weeks gestation were investigated for cytogenetic, haematological, biochemical and virological properties. In two patients with oligohydramnios, the fetoscope was introduced transabdominally into the fetal peritoneal cavity and sampling was undertaken from the intra-abdominal portion of the umbilical vein; in all the other patients an umbilical cord vessel was sampled. Ten (33%) of the fetuses had chromosomal abnormalities, one an erythroblastic process, possibly erythroleukaemia, one alpha-thalassaemia and one cytomegalovirus infection. Blood-film abnormalities were seen in 23 (88%) of 26 fetuses that had this examination. Biochemical analysis of fetal plasma was undertaken in 18 fetuses and hypoproteinaemia was found in all cases. One fetus was subsequently found to have a paroxysmal tachyarrhythmia that responded to digitilization. Three (10%) of the fetuses survived.

Adolescent↗
PubMed1986

Effect of gestational age on fetal and intervillous blood gas and acid-base values in human pregnancy.

Intervillous, umbilical venous and umbilical arterial blood samples were obtained by cordocentesis or fetoscopically from 200 pregnancies at 16-38 weeks gestation. The fetuses were either not affected by the condition under investigation or it was one which would not affect blood gas and acid-base status. Blood pH, pO2, pCO2, bicarbonate, base excess and plasma lactate concentration were determined and ranges for each parameter are presented. Samples obtained fetoscopically were more acidotic, hypercapnic and had a greater base deficit than those obtained by cordocentesis. In the umbilical venous samples, the pO2 decreased, while the bicarbonate, base excess and lactate increased with gestation. In the umbilical arterial samples the pO2 decreased and pCO2 increased; there were no other significant changes with gestation. Similarly, in the intervillous samples the only significant change with gestation was that of a decrease in pO2.

Acid-Base Equilibrium↗
PubMed1977

Sampling the fetoplacental circulation. II. Combined laparoscopy-fetoscopy in the pregnant ovine.

Induction of pneumoperitoneum, laparoscopy, and intrauterine endoscopy (fetoscopy) were successfully accompished in 23 pregnant sheep at 45 to 60 days' gestational age. The fetoscope, a conventional 2.7 mm. Hopkins straightforward wide-angle telescope (Stortz 27018A) encased in a prototype 3.1 mm. eccentric cannula, incorporates a 25 gauge needle channel. Multiple pregnancy was encountered in 11 animals. Forty-two separate fetoscopic trials were accomplished; a fetoplacental blood sample was obtained in 52 per cent of the trials. A mean interval of 19 +/- 9 days (+/- S.D., range 6 to 37 days) was allowed between fetoscopy trials. Fetal deaths occurred in nine animals (39 per cent). We believe that laparoscopy permits preselection of the proposed fetoscopy puncture site and will permit the operator to thereby avoid the placenta and/or uterine vessels.

Animals↗
PubMed1988

[Prenatal diagnosis of congenital anomalies--present status and future problems].

Technical advances continue to expand the number of genetic disorders that can be diagnosed in utero. The current methods for prenatal diagnosis are as follows: Amniocentesis, fetoscopy, fetal blood sampling, biopsy of fetal skin, and chorionic villus sampling (CVS). The method for growing fetal cells obtained by amniocentesis in short term culture and karyotyping has opened a new area to chromosomal anomalies. By using cultured amniotic fluid cells in larger numbers, it is also possible to diagnose many metabolic disorders. Fetoscopy has been developed which permits the perinatologist to enter the uterus and obtain tissue sample or to actually view the fetus. However, it is very difficult to visualize the fetus directly through fetoscope. Only specific parts of the fetus can be readily identified, but a total examination of surface anatomy is rarely possible. Now ultrasonography with improved resolution can clearly define many major anatomical abnormalities without apparent risk. And also, fetal blood sampling and skin biopsy have been successfully performed under ultrasound guidance rather than under direct fetoscopic visualization. Recently, the advent of fetal blood sampling has made it possible to diagnose genetic disorders which have hitherto been impossible to recognize in the fetus. The main applications are for the prenatal diagnosis of the fetal infection, coagulopathies, hemoglobinopathies, and muscular dystrophies. Several severe genodermatoses result in early death or are associated with significant morbidity. Some of these disorders can be diagnosed in utero with skin biopsies. Harlequin Ichthyosis is a typical case. A positive prenatal diagnosis of Harlequin Ichthyosis was reported.(ABSTRACT TRUNCATED AT 250 WORDS)

Amniocentesis↗
PubMed1987

Clinical aspects of fetal heart auscultation.

The widespread belief that fetal heart tones are first detected with an unamplified fetoscope at about 20 weeks' gestation has been studied prospectively only twice. Using data collection prospectively from 352 visits of 77 patients between 15 and 23 weeks' pregnancy, we studied various clinical aspects of fetal heart tone detection. We determined the gestational age at the time of initial auscultation of fetal heart tones with an ordinary fetoscope, and its relationship to quickening, parity, and placenta location. Fetal heart tones were first identified by auscultation at a mean gestational age of 19.4 weeks (range 17-22 weeks). Detection was possible in 81% of patients examined at 20 weeks and in virtually all patients examined at 21 weeks or later. Once heard, fetal heart tones were identified in every subsequent visit for all patients. Parity and placenta location were significant factors influencing initial fetal heart tone detection. Auscultation preceded quickening in only 12% of patients. Recommendations for using initial fetal heart tone detection in clinical practice are given.

Female↗
PubMed1990

Fetal laser surgery in genetic polydactyly mice.

The first digital ray of the hindlimb plate in Slc:ICR mouse fetus was irradiated with 2 watts argon laser beam for 0.3 sec after releasing from the abdominal cavity and envelop of uterine myometrium on day 13 of gestation, and then the fetuses were allowed to develop in the abdominal cavity contacting with the uterus via the placenta exo utero until term. ICR mouse fetuses which received fetal laser surgery lost their first digits completely, resulting in 4-digit hindfoot on day 18 of gestation. The homozygous Polydactyly Nagoya (Pdn/Pdn) mice exhibit 1-3 extra digits both in the fore- and hindlimbs preaxially. The extra digital rays in the left hindlimbs of Pdn/Pdn fetuses were irradiated with 2 watts argon laser beam for 0.3 sec on day 13 of gestation exo utero. The left hindlimbs of the Pdn/Pdn fetuses which received fetal laser surgery lost their preaxial extra digits on day 18 of gestation, resulting in 5 digits, though their 1st digit was triphalangia. The combination of a laser instrument with the fetoscope and/or ultrasound scanner may promote the fetal surgery of congenital anomalies in humans.

Animals↗