Therapeutic Indications of Fetoscopy: A 5-Year Institutional Experience

Peiró, José L.; Carreras, Elena; Guillén, Gabriela; Arévalo, Sílvia; Sánchez‐Durán, María Ángeles; Higueras, Teresa; Castillo, Felix; Marhuenda, C; Lloret, Jorge López; Martínez-Ibáñez, Vicente

doi:10.1089/lap.2007.0149

Cited by 22 publications

(18 citation statements)

References 44 publications

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“…One article did not specify the precise gestational age at iPPROM and was excluded from this calculation. Infants were born at a mean gestational age of 33 (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) weeks with a mean neonatal survival rate of 91% in the 18 liveborn cases and 69% (17-100%) in the remaining fetuses.…”

Section: Shunting For Lutomentioning

confidence: 99%

Preterm Prelabor Rupture of Membranes and Fetal Survival after Minimally Invasive Fetal Surgery: A Systematic Review of the Literature

Beck¹,

Lewi²,

Gucciardo³

et al. 2011

Fetal Diagn Ther

126

138

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Objective: Iatrogenic preterm prelabor rupture of membranes (iPPROM; <37 weeks of gestation) is a major complication of fetal surgery. Little information is available about risk factors and incidence. Methods: We systematically reviewed reported iPPROM rates, gestational age at delivery and fetal survival after representative minimally invasive antenatal procedures. Results: A total of 1,146, 36 and 194 cases with mean iPPROM rates of 27, 31 and 26% were included for placental laser in twin-twin transfusion syndrome, shunting in lower urinary tract obstruction and interventions for twin-reversed arterial perfusion, respectively. In the statistical analysis, the maximum diameter of the instrument predicted iPPROM rate and was significantly related to gestational age at birth as well as fetal survival. Information on duration of the respective procedures was scarce and did not allow for meaningful analysis. Conclusions: iPPROM occurs in about 30% of cases treated by minimally invasive fetal surgery. The maximum diameter of the instrument explains iPPROM rate, gestational age at birth and fetal survival. Great variations in the reporting of iPPROM make data analysis difficult.

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Section: Shunting For Lutomentioning

confidence: 99%

Preterm Prelabor Rupture of Membranes and Fetal Survival after Minimally Invasive Fetal Surgery: A Systematic Review of the Literature

Beck¹,

Lewi²,

Gucciardo³

et al. 2011

Fetal Diagn Ther

126

138

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“…Fetal tracheal occlusion was then suggested as an alternative, since this procedure was shown to stimulate fetal lung growth in both animal models and humans [22][23][24][25][26][27][28][29][30][31][32][33][34] . Different techniques to access the fetal trachea were applied.…”

mentioning

confidence: 99%

“…Minimally invasive approaches have been performed with the introduction of a thinner fetoscope under ultrasound guidance by puncturing the maternal skin, the uterus and the amniotic cavity, a procedure called transcutaneous fetal endoscopic tracheal occlusion (FETO) [23][24][25][26][27][28][29][30][31][32][33][34] . The results of FETO reported in the literature among different centers remain controversial.…”

mentioning

confidence: 99%

Comparison between Fetal Endoscopic Tracheal Occlusion Using a 1.0-mm Fetoscope and Prenatal Expectant Management in Severe Congenital Diaphragmatic Hernia

Ruano¹,

Duarte²,

Pimenta³

et al. 2010

Fetal Diagn Ther

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Objectives: To evaluate if fetal endoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia (CDH) using a 1.0-mm fetoscope improves neonatal outcome. Method: Between January 2006 and December 2008, a controlled study was conducted at a single center in which FETO was proposed for fetuses with severe isolated CDH (lung-to-head ratio <1.0) and liver herniation to the thoracic cavity but no other detectable anomalies at diagnosis (<26 weeks). FETO was performed under maternal epidural and fetal intramuscular anesthesia, guided by ultrasonography and 1.0-mm fetoscope between 26 and 30 weeks. All cases submitted to FETO were delivered by ex utero intrapartum therapy procedure. Postnatal therapy was the same for both treated fetuses and controls. The primary outcome was neonatal survival (up to 28 days after birth). Results: A total of 35 women met the inclusion criteria, and in 17 of them, fetal intervention was intended. However, in 1 case, it was not possible to insert the balloon inside the fetal trachea because of placental bleeding. FETO was therefore successfully performed in 16 fetuses with severe CDH. Eighteen cases received no prenatal intervention and served as the control group. Mean gestational age at diagnosis was similar in both groups (p > 0.05). Delivery occurred at 35.6 (range: 28–38) weeks in the FETO group and at 37.5 (range: 31–40) weeks (p = 0.18) among controls. Nine of 17 (52.9%) infants in the FETO group and 1 of 18 (5.6%) in the control group survived (p < 0.01). Severe pulmonary arterial hypertension was present in 8/17 (47.1%) infants from the FETO group and in 16/18 (88.9%) controls (p = 0.01). Conclusion: The present study shows that FETO using a 1.0-mm fetoscope is feasible and may improve neonatal outcome in severe CDH.

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“…This cannula enables the surgeon to change instruments during the intervention and, in theory, reduces membrane friction, however, at the expense of a larger diameter. The port can be inserted into the amniotic cavity using a stabbing trocar or over a guide wire and dilator (Seldinger technique) [29,[38][39][40]. Alternatively, the fetoscope sheath can be inserted directly, using a pyramidal obturator within.…”

Section: Instrumentsmentioning

confidence: 99%

The use of endoscopy in fetal medicine

Beck¹,

Pexsters²,

Gucciardo³

et al. 2010

Gynecol Surg

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We aimed to review the state of affairs in the field of embryo-fetoscopy as well as its instrumental requirements. Today, endoscopic procedures of limited complexity are easily possible within the amniotic cavity. Embryoscopy is typically done for diagnostic purposes, such as the demonstration of external anomalies very early in pregnancy and/or obtaining embryonic tissues in recurrent miscarriages. Fetoscopy is the direct visualization of the amniotic cavity from the second trimester onwards. Its principal indications are complications of monochorionic twinning and severe congenital diaphragmatic hernia. There is level I evidence that fetoscopic laser surgery for twintwin-transfusion syndrome is superior over amniodrainage. Fetoscopic endoluminal tracheal occlusion is done for severe diaphragmatic hernia. Whether tracheal occlusion yields better outcomes than expectant management during pregnancies is currently being investigated in a randomized trial. There are a number of less common procedures discussed as well. Overall, maternal risks of embryofetoscopy are minimal. The most frequent complication is rupture of the membranes and as a consequence preterm delivery. Fetal surgery seems safe and has, therefore, become a clinical reality. Although the stage of technical experimentation is over, most interventions remain investigational. Inclusion of patients into trials whenever possible should be encouraged, rather than building up casuistic experience.

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Therapeutic Indications of Fetoscopy: A 5-Year Institutional Experience

Cited by 22 publications

References 44 publications

Preterm Prelabor Rupture of Membranes and Fetal Survival after Minimally Invasive Fetal Surgery: A Systematic Review of the Literature

Preterm Prelabor Rupture of Membranes and Fetal Survival after Minimally Invasive Fetal Surgery: A Systematic Review of the Literature

Comparison between Fetal Endoscopic Tracheal Occlusion Using a 1.0-mm Fetoscope and Prenatal Expectant Management in Severe Congenital Diaphragmatic Hernia

The use of endoscopy in fetal medicine

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