Heated humidified carbon dioxide for partial uterine insufflation in fetoscopic myelomeningocele repair: insights from animal model

Cortés, Magdalena Sanz

doi:10.1002/uog.20227

Cited by 3 publications

(5 citation statements)

References 36 publications

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“…The potential for fetal acidosis from CO 2 based on ovine model observations is one of the major concerns with fetoscopic OSB closure [31][32][33][34]. However, partial insufflation with heated, humidified CO 2 appears to lessen both fetal acid base changes [35,36] and the inflammatory reaction in the peritoneum and fetal membranes that may contribute to SROM compared to cold, dry CO 2 [36][37][38]. For these reasons, we switched to heated humidified CO 2 .…”

Section: Discussionmentioning

confidence: 99%

Implementation Process and Evolution of a Laparotomy-Assisted 2-Port Fetoscopic Spina Bifida Closure Program

et al. 2021

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Introduction: Prenatal closure of open spina bifida via open fetal surgery improves neurologic outcomes for infants in selected pregnancies. Fetoscopic techniques that are minimally invasive to the uterus aim to provide equivalent fetal benefits while minimizing maternal morbidities, but the optimal technique is undetermined. We describe the development, evolution, and feasibility of the laparotomy-assisted 2-port fetoscopic technique for prenatal closure of fetal spina bifida in a newly established program. Methods: We conducted a retrospective cohort study of women consented for laparotomy-assisted fetoscopic closure of isolated fetal spina bifida. Inclusion and exclusion criteria followed the Management of Myelomeningocele Study (MOMS). Team preparation involved observation at the originating center, protocol development, ancillary staff training, and surgical rehearsal using patient-matched models through simulation prior to program implementation. The primary outcome was the ability to complete the repair fetoscopically. Secondary maternal and fetal outcomes to assess performance of the technique were collected prospectively. Results: Of 57 women screened, 19 (33%) consented for laparotomy-assisted 2-port fetoscopy between February 2017 and December 2019. Fetoscopic closure was completed in 84% (16/19) cases. Over time, the technique was modified from a single- to a multilayer closure. In utero hindbrain herniation improved in 86% (12/14) of undelivered patients at 6 weeks postoperatively. Spontaneous rupture of membranes occurred in 31% (5/16) of fetoscopic cases. For completed cases, median gestational age at birth was 37 (range 27–39.6) weeks and 50% (8/16) of women delivered at term. Vaginal birth was achieved in 56% (9/16) of patients. One newborn had a cerebrospinal fluid leak that required postnatal surgical repair. Conclusion: Implementation of a laparotomy-assisted 2-port fetoscopic spina bifida closure program through rigorous preparation and multispecialty team training may accelerate the learning curve and demonstrates favorable obstetric and perinatal outcomes.

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Section: Discussionmentioning

confidence: 99%

Implementation Process and Evolution of a Laparotomy-Assisted 2-Port Fetoscopic Spina Bifida Closure Program

et al. 2021

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“…11-15, 28, 29 More recent animal studies demonstrated that using heated, humidified gas may mitigate the fetal acid-base disturbances secondary to CO 2 insufflation. 16,28,29 As hypothesized by Amberg et al, heating CO 2 gas reduces its solubility while humidification reduces the intra-amniotic partial pressure of CO 2 , due to the contribution of water vapor pressure. 28 In combination, these alternations may lead to reduced absorption of CO 2 in fetuses exposed to heated, humidified gas.…”

Section: Resultsmentioning

confidence: 98%

“…Perioperative characteristics of the cases are displayed in Table 1. Maternal age was 32 (28)(29)(30)(31)(32)(33)(34)(35)(36) There were no instances of significant procedural complications, including fetal or maternal bleeding, need for emergent cesarean delivery, or fetal death. During the procedure, 2 (28.6%) cases had brief episodes of fetal bradycardia detected, both of which lasted less than 15 seconds.…”

Section: Resultsmentioning

confidence: 99%

“…The placentomes are connected by exposed inter-cotyledonary vessels that traverse the myometrium and may be distended during uterine CO 2 insufflation, thus potentially providing increased surface area for fetal absorption of CO 2 . 29,[32][33][34] Alternatively, as proposed by M. Sanz Cortez et al, the easily distensible myometrium and numerous cotyledons connected by fetal vessels may lead to stretching and compression of the surface vessels, and ultimately inefficient CO 2 clearance. 29 This is unlike the human placenta where cotyledons are clustered within the discoid hemochorial placenta, and the majority of fetal vessels are protected by the underlying chorionic plate, which is presumed to prevent over-distension of fetal vessels.…”

Section: Resultsmentioning

confidence: 99%

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Fetal blood gases after in utero carbon dioxide insufflation for percutaneous fetoscopic spina bifida repair

Sangara

Chon

Speybroeck

et al. 2021

American Journal of Obstetrics & Gynecology MFM

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“…Heated and humidified CO 2 gas for partial amniotic carbon dioxide insufflation is used in an attempt to decrease the risk of membrane desiccation and inflammation with subsequent membrane weakening. 142,[145][146][147] Recent animal and human data suggest safety without evidence of fetal acidemia by fetal umbilical vein sampling, including a series of seven patients who underwent percutaneous fetoscopic spina bifida repair. [148][149][150] In addition, CO 2 exposure in utero does not appear to adversely affect postsurgical fetal or postnatal growth.…”

Section: The Percutaneous Fetoscopic Technique Is Per-mentioning

confidence: 99%

Advances in Fetal Surgical Repair of Open Spina Bifida

Chmait

Monson

Chon

2023

Obstetrics &Amp; Gynecology

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Spina bifida remains a common congenital anomaly of the central nervous system despite national fortification of foods with folic acid, with a prevalence of 2-4 per 10,000 live births. Prenatal screening for the early detection of this condition provides patients with the opportunity to consider various management options during pregnancy. Prenatal repair of open spina bifida, traditionally performed by the open maternal-fetal surgical approach through hysterotomy, has been shown to improve outcomes for the child, including decreased need for cerebrospinal fluid diversion surgery and improved lower neuromotor function. However, the open maternal-fetal surgical approach is associated with relatively increased risk for the patient and the overall pregnancy, as well as future pregnancies. Recent advances in minimally invasive prenatal repair of open spina bifida through fetoscopy have shown similar benefits for the child but relatively improved outcomes for the pregnant patient and future childbearing.

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Heated humidified carbon dioxide for partial uterine insufflation in fetoscopic myelomeningocele repair: insights from animal model

Abstract: https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.20180

Cited by 3 publications

References 36 publications

Implementation Process and Evolution of a Laparotomy-Assisted 2-Port Fetoscopic Spina Bifida Closure Program

Implementation Process and Evolution of a Laparotomy-Assisted 2-Port Fetoscopic Spina Bifida Closure Program

Fetal blood gases after in utero carbon dioxide insufflation for percutaneous fetoscopic spina bifida repair

Advances in Fetal Surgical Repair of Open Spina Bifida

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