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PubMed1978

Sampling the fetoplacental circulation. III. Combined laparoscopy-fetoscopy in the pregnant macaque for hemoglobin identification.

To demonstrate increased technical experience with fetoscopy and fetal blood sampling, two groups of macaques were compared to control animals. Group 2 had a perinatal mortality rate that was not significantly different from that of the control group. A 2.7 mm. Hopkins rod lens endoscope encased in an eccentric cannula, 3.8 mm. outside diameter, was used. When compared to the earlier test group (Group 1), the later test group (Group 2) showed greater adequacy of the fetal blood sample for laboratory analysis (P less than 0.01). Anthropometric and hematologic data collected at term births compared favorably in test and control groups, with the exception of the white blood cell count, which was significantly lower with fetoscopy (P less than 0.01). This is the first report of experimental fetoscopy with the use of a control group to provide precise data to aid in clarification of the ethical issues yet unresolved in this technology.

Animals↗
PubMed1979

Fetoscopy in the practice of perinatology and obstetrics.

The clinical indications for fetoscopy in perinatal medicine are encompassing an ever widening circle of inherited diseases and teratologically induced disorders that can now or potentially be diagnosed in utero. Fetoscopy, which has evolved over the past 20 years into a clinically accepted procedure, is not without risk to the pregnant mother and the fetus. When the decision is made to perform the procedure, its merits should outweigh its inherent risks and it should be performed by a perinatologist experienced in the technique. Fetoscopy is appropriate when the fetus is at risk for teratologically induced malformation, inherited blood dyscrasias, sex-linked or autosomal abnormalities with gross malformations, or neural tube disorders that cannot be diagnosed by amniocentesis. Technical improvements should result in increased refinement and wider applicability of the technique in the future.

Congenital Abnormalities↗
PubMed1983

Development of a nonhuman primate model for fetoscopy.

Twenty-four fetoscopy procedures were performed on 22 monkeys (19 Macaca mulatta, one M. fascicularis, two Erythrocebus patas) with gestational ages ranging from 66 to 145 days. Insertion of the fetoscope without ultrasound guidance was easy in 14 and difficult in ten procedures. Amniotic fluid exchange with normal saline, to improve visualization, was successful in eight of 13 procedures. Fetal blood sampling was successful in four of nine attempts. Nine monkeys aborted within 17 days of the fetoscopy, the remaining 13 went to term or were used in other research protocols. Major complications included maternal hemorrhage into the amniotic fluid, inability to enter the amniotic cavity, and abortion. Maternal serum alpha-fetoprotein following fetoscopy was not a useful indicator of subsequent abortion.

Abortion, Spontaneous↗
PubMed1982

Evaluation of diagnostic fetoscopy.

The authors evaluate the efficacy and safety of fetoscopy on a series of 510 patients in which the procedure was carried out between the 18th and 20th week of gestation in order to obtain a suitable fetal blood sample for prenatal genetic diagnosis; the whole pregnancy could be completely followed up in them. The complication rate was low (1.7%) when the first attempt of fetoscopy was successful, but rose dramatically up to 17.9% on repeated attempts: however, they only amounted to 7.8% of all cases. The results of their study lead the authors to propose fetoscopy as a powerful, accurate and safe addition to the presently available diagnostic methods, provided it is performed by well trained fetoscopists, under aseptic conditions and local anaesthesia.

Abortion, Therapeutic↗
PubMed1981

Establishment of a fetoscopy and fetal blood sampling program in Israel.

The development of fetoscopy and the ability to obtain fetal blood samples have made possible the prenatal diagnosis of diseases not diagnosable by amniocentesis. Foremost among these disorders are the hemoglobinopathies. We report our experience in establishing the first program for fetoscopy and fetal blood sampling in the Middle East. The results demonstrate that the experience and training required for a fetoscopy and fetal blood sampling program can be obtained in about one year. During that year, 23 couples who fetuses were at risk for a hemoglobinopathy learned the genetic status of their fetuses.

Abortion, Spontaneous↗
PubMed1980

The role of fetoscopy in antenatal diagnosis.

The application of fetoscopy has been limited thus far, but many uses can be envisioned for the future. Fetal blood sampling via fetoscopy provides information concerning haemoglobinopathies, various enzymatic activities, immunological competence, and haematological status. In addition to direct visualization for fetal malformations, fetoscopy could prove useful for intrauterine therapeutics. For example, intrauterine transfusion under direct visualization would allow earlier treatment of Rh-sensitized erythroblastoic fetuses, and administration of pharmacological agents and nutrients seems feasible.

Creatine Kinase↗
PubMed1980

Effects of maternal sedation during fetoscopy.

While instituting a new program in fetoscopy, the authors explored the effects of sedation with meperidine (Demerol) and promethazine HCl (Phenergan) during fetoscopy conducted on 10 mothers at 14 to 18 weeks' gestation. Each received 100 mg of meperidine and 50 mg of promethazine HCl approximately 30 minutes before the procedure. In 3 instances, a repeat half-dose injection was made at 30 minutes for adequate analgesia. Sex of the fetus was determined accurately in 9 instances. In 9 of 10 cases, visualization was satisfactory; technical problems in 1 case precluded visualization. Complications included 2 superficial fetal limb hematomas and 2 instances of minimal fetal bleeding from an unknown site. Three patients required perforation of anterior placentas. Amniotic fluid was invariably clear but became progressively turbid. Sedation allowed a longer period for clear amniotic fluid by decreasing fetal movements progressively over the first hour; fetal activity showed a prompt return thereafter. The clarity of the amniotic fluid was adversely influenced by external manipulation of the fetus. The authors conclude that sedation has obvious benefits for the mother and may facilitate evaluation of the fetus during fetoscopy.

Adult↗
PubMed1977

Limitations of visualization of the entire fetus by means of second-trimester fetoscopy.

Fetoscopy with rigid fiber optics was performed under general anesthesia in 9 patients scheduled for therapeutic abortion by hysterotomy with a duration of pregnancy between 12 and 18 weeks. Visualization of fetus and placenta was found to be at random chance and incomplete, and could not be improved by internal or external manipulation. Skin biopsies were obtained in 5 cases. The cord could be recognized in all cases. It is concluded that the haphazard and incomplete visualization of the uterine contents at present precludes the application of second-trimester fetoscopy for early detection of visible congenital fetal abnormalities.

Abortion, Therapeutic↗
PubMed1999

Gelatin sponge plug to seal fetoscopy port sites: technique in ovine and primate models.

Amniotic fluid leakage and rupture of membranes are common complications of fetoscopy. We describe a plug technique for leakproof removal of endoscopic cannulas. Thirty gelatin sponge plugs were introduced in 5 pregnant ewes and 5 pregnant rhesus monkeys. In the primate model no evidence of amniorrhexis was noted on postoperative ultrasonography. Myometrium and membranes at the port sites were intact at term. A gelatin sponge plug technique may facilitate leakproof port removal after fetoscopy.

Amniotic Fluid↗
PubMed1978

Early prenatal diagnosis of neural-tube defects by ultrasound-guided fetoscopy.

In three fetuses with neural-tube defects (N.T.D.s) the lesions were clearly seen by fetoscopy in the second trimester. In a fourth fetus, in which the diagnosis of N.T.D. was suspected because of raised amniotic-fluid alpha-fetoprotein, spina bifida was excluded by fetoscopic examination and a normal baby was delivered at term. Ultrasound-guided fetoscopy has a place in the diagnosis of N.T.D.s when the results of other investigations are conflicting or inconclusive, and may be useful in assessing the severity of a lesion.

Amniocentesis↗
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↗
PubMed2000

Matrix metalloproteinases -2 and -9 and their endogenous tissue inhibitors in fetal membrane repair following fetoscopy in a rabbit model.

The cellular mechanisms underlying fetal membrane repair are poorly understood. Matrix metalloproteinases (MMP) and the endogenous tissue inhibitors of metalloproteinases (TIMP) play a key role in the control of turnover of extracellular matrix in fetal membranes at normal parturition and preterm prelabour rupture of the fetal membranes (PPROM). The time course of secretion of MMP-2 (72 kDa, gelatinase A) and MMP-9 (92 kDa, gelatinase B) and TIMP into extra-embryonic coelomic, allantoic and amniotic fluids in a rabbit model was examined. Furthermore, to evaluate their role in fetal membrane repair, the changes induced by fetoscopy at mid-gestation (23 days; gestation length is 32 days) were investigated. Zymography showed predominantly secretion of latent MMP-2 at 18, 23 and 30 days of gestation in all gestational compartments. Reverse zymography detected a broad range of TIMP activity with molecular weights of 27-30 kDa (TIMP-1, glycosylated TIMP-3 and TIMP-4), 24 kDa (unglycosylated TIMP-3) and 21 kDa (TIMP-2). Following fetoscopy, both MMP-2 and TIMP increased significantly in amniotic fluid and extra-embryonic coelomic fluid, but not in allantoic fluid, as demonstrated by densitometric analyses. These findings indicate a modulating role for MMP and TIMP in the repair processes following a surgically induced fetal membrane defect.

Animals↗
PubMed1984

Fetoscopy in prenatal diagnosis of the Majewski and the Saldino-Noonan types of the Short Rib-Polydactyly syndromes.

Fetoscopy was performed in three pregnancies at risk for the Majewski syndrome and in one pregnancy at risk for the Saldino-Noonan syndrome of the fetus. One case of Majewski syndrome and two normal fetuses were correctly diagnosed. In the remaining case the amniotic fluid was blood-stained and the fetus could not be visualized. Patients previously carrying a fetus with a Short Rib-Polydactyly syndrome of the Majewski or Saldino-Noonan types are at a high risk of recurrence (25%) and should be offered prenatal diagnosis in subsequent pregnancies. Polydactyly is consistently present in these syndromes, and is easily seen through the fetoscope. Fetoscopy offers a safe and instant diagnosis as early as 15-16 weeks of gestation.

Adult↗
PubMedDate not supplied

Infrared fetoscopy in the sheep.

The strong light sources used in fetoscopy and embryoscopy may cause eye injuries to the fetus. To circumvent this potential hazard, we have successfully used an infrared light source and infrared video camera to perform 'night vision' fetoscopy in a fetal lamb model.

Animals↗
PubMed1998

Fetoscopy.

Fetoscopy involves the application of microlaparoscopic technology to fetal diagnosis and therapeutic intervention. Though fetoscopy presents many potential advantages over open fetal surgery, the primary one is that of decreased procedure-induced preterm labor and fetal loss from preterm delivery. The small uterine puncture sites required for fetoscopic surgery should, in theory, obviate the morbidity of a large hysterotomy. Fetoscopic instrumentation is small by design, but this has not limited the breadth of the interventional spectrum, because creative applications have been used for the treatment of twin-twin transfusion syndrome, twin reversed arterial perfusion sequence, hydronephrosis, congenital diaphragmatic hernia, fetal tumors, and myelomeningocele. This article examines the fetoscopic experience for these applications, involving over 150 cases. The results for many procedures are auspicious and will improve as further operative experience and newer fetoscopic technologies become available. However, as with any novel technology, responsible application must involve careful experimentation and an analysis of potential maternal and fetal benefits.

Animals↗
PubMed1980

Transvaginal fetoscopy in anterior placentas.

When the placenta is located anteriorly, fetoscopy by the abdominal route may be impracticable. An alternative route, i.e., insertion of the fetoscope through the anterior vaginal fornix, was used in 31 women in midpregancy. Twenty-six of the women had been admitted for therapeutic abortion; the remaining five, for diagnosis. The insertion of the instrument was uncomplicated in all 31 women. In three of the five diagnostic cases, the disease at risk was excluded. The three women continued their pregnancies, and two of them went on to term without complications. The third woman had intermittent leakage of amniotic fluid. At 33 weeks she was delivered of a normal infant (birthweight 2 150 g). Transvaginal fetoscopy may be considered when an anterior placenta has an extension so broad that the abdominal approach is unfeasible.

Abortion, Therapeutic↗
PubMed1984

Sinusoidal rhythm caused by fetal hemorrhage during fetoscopy.

The sinusoidal fetal heart rate pattern has been reported to be associated with fetal anemia, hypoxia, administration of alphaprodine while, in other cases, it has been followed by good fetal outcome. In this case study fetoscopy was performed in a patient with thalassemia trait for prenatal diagnosis of thalassemia. Following the insertion of the trocar, bloodstained amniotic fluid was aspirated which resulted to be all fetal in origin. Estimation of feto-maternal hemorrhage was 5.7 ml while the amount of intra-amniotic bleeding could not be assessed. Fetal heart rate, which was recorded throughout fetoscopy, showed a sinusoidal pattern starting two minutes after the fetal hemorrhage which lasted more than ten minutes. Two hours later the fetal heart rate was normal. The pregnancy continued uneventfully and a healthy female baby weighing 3100 g was delivered at 38 weeks' gestation. Review of the literature suggests that a sinusoidal pattern may be caused either by a hemodynamic disturbance or fetal acidosis. In any case it does not always indicate impending fetal death.

Adult↗
PubMed1982

Amniocentesis and fetoscopy.

Amniocentesis and fetoscopy are two of several modalities used to offer information during the prenatal period of the status of the fetus. Amniocentesis is most frequently used and with continuing research is becoming an invaluable aid to prenatal diagnosis. With the recent studies of DNA characteristics of globin chains of cells obtained at amniocentesis, the need to obtain blood directly from fetal vessels to diagnose major hemoglobinopathies prenatally is rapidly diminishing. Open neural tube defects are diagnosable with alpha feto protein analysis. All chromosomal defects are accurately quantitated and more than 100 inborn errors of metabolism are predictable. Fetoscopy is a technique which has a limited utility. It should be confined to major centers where adequate midtrimester abortions are done in order to provide training for those who aspire to pursue this method. With fetal blood sampling the following conditions are detected: beta thalassemia major, Hemophilia A, sickle cell anemia, chronic granulomatous disease, galactosemia and Tay Sachs disease, all of which may be diagnosed directly. Alpha and beta thalassemia, Hemophilia B and homozygous Von Willenbrand's disease may be excluded. With fetal biopsy one can diagnose congenital bullous ichthyosiform erythroderma ichthyosis. During the last ten years the amount of information brought to our attention has also brought the expectation that the next decade will be the most fruitful period in our history in this discipline.

Adult↗