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We tested the feasibility of treating placental vascular anomalies with a fetoscopically delivered neodymium-yttrium-aluminum-garnet laser in pregnant ewes. This laser provided sufficient power in an amniotic fluid medium to occlude placental vessels as large as 7 mm in diameter within 6 seconds at a power density of 2000 W/cm2.
We tested the feasibility of photocoagulating placental vascular communications with a fetoscopically delivered neodymium:yttrium-aluminum-garnet laser in 12 pregnant monkeys in the second trimester. The technique was successful in eight cases. One ended in spontaneous labor 2 weeks after occlusion and one stillbirth occurred at term. Six live fetuses were delivered at term, with all treated vessels demonstrating occlusion. There was minimal placental damage at the laser impact sites, and no fetal abnormalities were detected. Long-term occlusion of placental vasculature can be accomplished by fetoscopically delivered laser energy.
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The ability of ultrasound to diagnose fetal anomalies is limited in the early stages of gestation. We describe a microendoscope that can be used with an 18-gauge needle at the time of amniocentesis to provide more precise diagnostic information when the first-trimester ultrasound examination suggests a problem.
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