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At least 271 records · Page 15Linked to original sources
PubMed1996

Fetal endoscopic ('Fetendo') tracheal clip.

Fetal surgery can correct several life-threatening malformations before birth. Despite recent advances in fetal surgery, preterm labor remains a major problem directly related to the large uterine incision required for fetal exposure. Fetal endoscopic surgery ("Fetendo") obviates the need for a large uterine incision and may reduce the overall risks of fetal surgery by causing less uterine trauma and ultimately less preterm labor. Temporary tracheal occlusion is a promising strategy to enlarge the lungs in fetuses with congenital diaphragmatic hernia. Using the technology developed for laparoscopic surgery and for temporary tracheal occlusion, we have developed an endoscopic technique for tracheal occlusion with an endoscopic clip in a fetal sheep model. The evolution of this technique may allow temporary tracheal occlusion without incisional hysterotomy or maternal laparotomy.

Animals↗
PubMed1979

Plasma assay of fetal factors VIIIC and IX for prenatal diagnosis of haemophilia.

Fetal blood unmixed with maternal blood or amniotic fluid was obtained by direct-vision fetoscopy in 22 consecutive cases at 15--22 weeks' gestation; the investigation was done either for prenatal diagnosis or before therapeutic abortion. Fetal plasma factors VIIIC and IX averaged 50 I.U./dl (S.D. 12.8) and 12.5 I.U./dl (S.D. 2.4), respectively. Two male fetuses at risk of haemophilia had normal factor VIIIC levels by these criteria, and both pregnancies ended in the birth of a normal boy. Five others gave 3 normal and 2 haemophilic results, which were confirmed in two of the three terminated pregnancies.

Amniocentesis↗
PubMed1983

Antenatal diagnosis of genodermatoses.

The technics of fetoscopy and fetal skin biopsy have expanded our capabilities for antenatal diagnosis of certain hereditary skin disorders (genodermatoses). The fetus and placenta can be visualized directly and skin biopsy specimens can be obtained for light and electron microscopic studies, tissue culture, and biochemical analysis. These technics have been utilized successfully in the prenatal diagnosis or exclusion of epidermolysis bullosa, epidermolytic hyperkeratosis, and harlequin ichthyosis in fetuses known to be at risk for these disorders, and they offer tremendous potential for prenatal diagnosis in a variety of other genodermatoses. Studies of tissue obtained by this procedure will undoubtedly expand our knowledge of the morphogenesis and biochemistry of fetal skin and will provide needed baseline data for the further development of these technics.

Biopsy, Needle↗
PubMed2003

Minimal access fetal surgery.

The development of fetal surgery has led to promising therapeutic options for a number of congenital malformations. However, preterm labor (PTL) and premature rupture of membranes continue to be ubiquitous risks for both mother and fetus. To reduce maternal morbidity and the risk of prematurity, minimal access surgical techniques were developed and are increasingly employed. Congenital diaphragmatic hernia (CDH), obstructive uropathy, twin-to-twin transfusion syndrome (TTTS), and sacrococcygeal teratoma have already been successfully treated using minimal access fetal surgical procedures. Other life-threatening diseases as well as severely disabling but not life-threatening conditions are potentially amenable to treatment. The wider application of minimal access fetal surgery depends on a continued improvement in technology and a better understanding of complications associated with fetal intervention.

Congenital Abnormalities↗
PubMed1997

Embryoscopy and early prenatal diagnosis.

Embryoscopy is a new technique that allows direct visualization of the embryo/fetus as early as the first trimester of pregnancy. A rigid fiberoptic endoscope is passed transcervically into the extracoelomic cavity and is used to identify developmental milestones and diagnose structural anomalies. Fetal blood sampling has also been performed, and using this technology, has established the feasibility of access to the human embryonic circulation. Future applications for embryoscopy include direct targeted embryonic or fetal interventions, such as gene or stem cell therapy.

Congenital Abnormalities↗
PubMed1995

Toward fetal therapy using needle embryofetoscopy.

Our objective was to explore the feasibility of using both transvaginal endoscopy and transabdominal needle embryofetoscopy for early prenatal diagnosis. Our experience with both terminating and continuing pregnancies is presented in this report. Following the granting of informed consent, patients undergoing first-trimester terminations were invited to participate in this program. Initially, a transvaginal endoscope was used in these studies: a rigid fiberoptic endoscope 30 cm in length with a diameter of 1.5 mm. Subsequently, a specially designed 16-gauge, double-barrel needle sheath, equipped with a 0.8-mm fiberoptic endoscope and a customized 27-gauge heparinized needle were used. In either case, the endoscope was passed under ultrasound guidance into the exocelomic space, from which the anatomy of the embryo/fetus was scrutinized. For continuing pregnancies, patients were selected when at high risk for various dysmorphology syndromes. To date, we have successfully performed more than 300 transvaginal procedures, successfully visualized the fetus in 95% of cases, and verified sonographically suspected anomalies in all of the five cases studied. We have also performed 20 transabdominal procedures, 15 in terminating pregnancies and five in continuing pregnancies, without adverse effects. Our experience establishes the feasibility of first-trimester diagnostic endoscopy. This new development is expected to serve as a prelude for further studies that attempt to diagnose and treat congenital diseases in early pregnancy. Potential applications include gene and stem-cell therapy at a time when the embryo is immunologically naive.

Abortion, Induced↗
PubMed1990

[Laser spectroscopy--a new procedure in fetal monitoring].

Monitors for laser spectroscopy are available as an additional tool for foetal surveillance. Using this technique, continuous and non-invasive registration of four biochemical parameters (HbO2, HbR, blood volume and cytochrome aa3) can be performed. The calculation is based on the optical density after irradiation of the biological sample with pulsed laser light in the near-infrared range (755, 805, 845, 904 nm). We evaluated the new technique in a clinical trial of 20 patients. The application of the laser sensor was performed, using a modified amnioscope. During prenatal tracings in cases with suspect CTG patterns, hypoxia was not verified. In cases without late decelerations a decrease of the cytochrome aa3 signal was observed in less than 1%. During intrapartual measurements, near-infrared signals were compared with the result of the PO2 measurement in foetal blood analysis. We found a significant correlation for HbO2 and cytochrome aa3 with a correlation coefficient of r = 0.96 respectively r = 0.94. We conclude, that laser spectroscopy will potentially be of benefit for foetal monitoring as it might provide a basis for differentiation between foetuses at risk and non-hazardous cases.

Cardiotocography↗
PubMed1998

New visualization techniques for in utero surgery: amnioscopy with a three-dimensional head-mounted display and a computer-controlled endoscope.

Endoscopic fetal surgery may reduce preterm labor associated with open hysterotomy but is partially limited by current visualization technology. We investigated a three-dimensional (3D) imaging system coupled to a head-mounted display (3D-HMD) and also employed a computer-controlled zoom endoscope for noninsufflated amnioscopy. Pregnant sheep were prepared in aseptic fashion for general anesthesia. Uterine access was obtained following maternal laparoscopy. A 10-mm zoom endoscope (Vista Medical Technologies, Carlsbad, CA) was used to examine the fetus and uterine contents. Fetal limbs were exteriorized for microsurgery. A new system (Vista Medical Technologies) was attached to an operative microscope, permitting projection of a 3D image via an HMD. The fetus and umbilical cord were inspected using the zoom endoscope, which changes the depth of focus under computer control. Basic manipulations of the fetus and cord were easily completed. Real-time 3D fetal imaging was accomplished. The added depth perception enabled detailed fetal and placental examination, fostering manipulation of the fetus and cord. The HMD was adjusted to fit several surgeons, permitting a natural operative posture. This unit has the capacity to display any video, CT, MR, or ultrasound image as a picture-in-picture. The success of minimally invasive fetal surgery is in part dependent on the development of video technologies capable of providing both magnification and optimal resolution. The zoom endoscope affords excellent visibility of multiple surgical targets without instrument repositioning. A 3D HMD system such as this provides greater anatomic detail and an appreciation of fetal movements that may make intrauterine procedures more feasible.

Animals↗
PubMed1986

Fetoscopy.

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Female↗
PubMed1999

Obstetrical endoscopy.

Fetoscopy has been reintroduced in fetal diagnosis and therapy, as a result of instrumental innovations. It has been suggested that fetoscopy be used to guide endoscopic operations on the fetus, but this application is still in the experimental phase. Its use for surgical interventions on the placenta, umbilical cord, and to a lesser extent the fetal membranes, could be called 'obstetrical' endoscopy. Nd:YAG laser coagulation of chorionic plate vessels for feto-fetal transfusion syndrome is the most common operation carried out today. Survival rates of 60% or more have recently been reported on both sides of the Atlantic Ocean. Neurological morbidity does not exceed 6%, which compares favorably with serial amnioreductions and may become the most important incentive for performing the operation. A randomized trial comparing both therapies as a next step is being proposed. Fetoscopy has also been used for cord ligation, but because of the complexity of the operation and the high risk for preterm prelabor rupture of the membranes, other alternatives have been investigated. Most experience has been gathered with bipolar cord occlusion, a procedure which can be performed under ultrasound guidance. The instrumental considerations and potential complications of fetoscopy are discussed.

Female↗
PubMed1983

Fetoscopy.

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Biopsy↗