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PubMed2003

Fetoscopic surgery.

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Diseases in Twins↗
PubMed1998

Endoscopic excision and repair of simulated bilateral cleft lips in fetal lambs.

The use of nonpenetrating clips to accomplish wound closure as an alternative to suture in the repair of simulated cleft lips in partially exteriorized fetuses has been described previously. In this study, the fetus is approached endoscopically, and clipped (n = 8) and sutured (n = 4) intrauterine endoscopic repairs in six lambs (90- to 95-day gestation) are compared. Also used was a newly developed harmonic scalpel to create the defects in the fluid environment. Clipped repairs were nearly 10 times faster than sutured repairs (2.7 +/- 0.5 minutes compared with 24 +/- 4 minutes, respectively). Furthermore, suture incited foreign body inflammation, recruited monocytic inflammatory cells, and exhibited notable scarring. The comparison between clipped and sutured repairs extends the previous observations to the realm of endoscopy and reinforces the previous conclusions of this group that the nonpenetrating clip is more rapid and incites less inflammation than suture in fetal wound approximation and repair.

Animals↗
PubMed2006

Stage-related outcome in twin-twin transfusion syndrome treated by fetoscopic laser coagulation.

OBJECTIVE: To assess perinatal outcome in monochorionic twin pregnancies according to different stages of severe mid-trimester twin-twin transfusion syndrome managed by fetoscopic laser coagulation of the placental vascular anastomoses. METHODS: In a prospective study fetoscopic laser therapy was performed in 200 consecutive pregnancies with severe mid-trimester twin-twin transfusion syndrome at a median gestational age of 20.7 weeks (range 15.9-25.3 weeks). Outcome data were analyzed for the whole group and separately for each stage according to the Quintero staging system. RESULTS: The overall survival rate was 71.5% (286/400), with survival of both twins in 59.5% (119/200) and survival of at least one of the twins in 83.5% (167/200). The median gestational age at delivery of liveborn neonates was 34.3 weeks (range 23.1-40.4 weeks). There was a significant trend toward reduced survival rates with increasing stage (P=.038). The percentage of pregnancies with survival of both fetuses was 75.9% (22/29) for stage I, 60.5% (49/81) for stage II, 53.8% (43/80) for stage III, and 50% (5/10) for stage IV. At least one of the twins survived in 93.1% (27/29) at stage I, 82.7% (67/81) at stage II, 82.5% (66/80) at stage III, and 70% (7/10) at stage IV. The overall survival rate for donor fetuses was 70.5% (141/200) and for recipient fetuses, 72.5% (145/200). CONCLUSION: These data show that laser therapy is an effective therapeutic option for all stages of severe twin-twin transfusion syndrome and provide information to counsel patients according to the stage of the syndrome.

Arteriovenous Anastomosis↗
PubMed1989

Production of additional atypical alloantibodies in Rh(D)-sensitized pregnancies managed by intrauterine investigation methods.

The production of additional atypical alloantibodies by previously Rh(D)-alloimmunized antenatal patients can complicate the clinical management of both mother and fetus. The relative risks of stimulating additional antibodies following the use of intrauterine investigation methods currently used for the management of haemolytic disease of the newborn have been assessed. A significantly (P less than 0.05, X2) greater number of additional antibodies were detected during pregnancy in the group of pregnancies managed by intrauterine transfusion (IUT) (3/29) than in those managed without recourse to intrauterine investigation (0/50), although one of the patients in the IUT group produced a further antibody following a fetal blood sample but before an IUT had been carried out. The number of additional antibodies detected post-delivery was significantly greater (P less than 0.02) in pregnancies managed by intrauterine transfusion (2/10) than in those managed by fetal haematocrit determination alone (0/28).

Blood Specimen Collection↗
PubMed1978

ABO and Rh phenotyping of foetal blood obtained by foetoscopy.

Blood samples taken from the foetus by foetoscopy early in the 2nd trimester of pregnancy can be used for reliable blood grouping. However, the sampling technique is not perfect. In 5 out of 15 pregnant women, no foetal blood was obtained, although between 1 and 10 samples were taken on each occasion. One-third of 56 samples from the 10 women contained foetal blood. Contamination of samples with amniotic fluid varied, but did not interfere with the blood grouping. ABO and Rh typing of the foetus was possible even if the samples were contaminated with large amounts of maternal blood. In nine cases, blood grouping of the foetus was performed on red cells from foetoscopy samples. Control blood samples from the foetus following abortion were obtained in seven of these cases, and the foetoscopic results were confirmed.

ABO Blood-Group System↗
PubMed1980

Prenatal diagnosis of harlequin ichthyosis.

We report the successful prenatal diagnosis of ichthyosis in the fetus of a woman whose previous liveborn child was affected with "harlequin ichthyosis". The fetal diagnosis was established through analysis of ultrasonographically guided fetoscopic skin biopsies. These biopsies showed premature hyperkeratosis, most marked around hair follicles and sweat ducts, and forming plugs of hyperkeratotic debris. These observations were in distinct contrast to those in control fetuses, whose epidermis consists of squamous epithelium only a few cells in depth with minimal keratinization.

Adult↗
PubMed1983

Fetoscopic photography.

Fetoscopic visualization may be used for the prenatal diagnosis of external structural malformations of the fetus. Objective documentation of these fetoscopic findings would be desirable. The photographic equipment and techniques required for fetoscopic photography have been investigated, and the results of these investigations with standard fetoscopic instruments in current clinical usage are described. The factors evaluated include the light source, camera equipment, camera settings and film.

Female↗
PubMed1984

"Blind" versus direct vision technique for fetal skin sampling in cases for prenatal diagnosis.

Seven fetuses at risk of developing a serious inherited skin disorder (epidermolysis bullosa atrophicans generalisata gravis in 4, bullous ichthyosiform erythroderma in 2, and non-bullous ichthyosiform erythroderma in 1) were subjected to prenatal diagnosis by fetal skin sampling. The conventional "blind" biopsy procedure was used in the first 3 cases; a two-cannula technique (one cannula for the optic instrument and the other for the biopsy forceps) that permits biopsy of the skin under direct vision, was employed in the remaining 4 cases. With the "blind" technique, 8 to 10 biopsy specimens had to be taken to ensure that enough skin material would be available for the microscopic examination; only one specimen out of every two was found to consist of skin; the remainder comprised fetal membranes, myometrium, or trophoblast. In one case where the "blind" procedure has been used, leakage of amniotic fluid occurred and labor started in the 33rd week. With the two-cannula technique, the number of biopsy samples could be confined to two or three, and all proved to be of skin.

Biopsy↗
PubMed1995

Clinical usefulness of the dye-injection method for diagnosing premature rupture of the membranes in equivocal cases.

OBJECTIVE: In 1981, we preliminarily reported on the clinical value and safety of the intra-amniotic dye (Phenol-sulfonphthalein, PSP)-injection method for diagnosing PROM. In the current study, through examination of 64 equivocal cases in the midtrimester of pregnancy, we investigated the clinical efficacy of the PSP test. METHODS: In the present study we examined patients with equivocal PROM in their 14th week to 33rd week of gestation, whose findings were positive according to a combination of conventional diagnostic methods. The results of the PSP test and conventional diagnostic methods were compared with the final diagnosis of PROM. RESULTS: The conventional diagnostic methods showed an accuracy rate of 63.9%-70.5%, in contrast to the PSP test, which had a 100%-accuracy rate (p < 0.001). CONCLUSION: Using the PSP test in combination with amnioscopy, we have established a method of differentially diagnosing PROM. We have reconfirmed the clinical efficacy of the PSP test in 64 equivocal PROM cases.

Female↗