Fetoscope

Jai Ganesh · 2023-06-08 00:14:34

Fetoscope

Gist

Fetoscope: A device used to obtain information about a fetus within the uterus. There are two types of fetoscopes: A fiberoptic scope for looking directly at the fetus within the uterus and a stethoscope designed for listening to the fetal heart beat.

Summary

Fetoscopy is an endoscopic procedure during pregnancy to allow surgical access to the fetus, the amniotic cavity, the umbilical cord, and the fetal side of the placenta. A small (3–4 mm) incision is made in the abdomen, and an endoscope is inserted through the abdominal wall and uterus into the amniotic cavity. Fetoscopy allows for medical interventions such as a biopsy (tissue sample) or a laser occlusion of abnormal blood vessels (such as chorioangioma) or the treatment of spina bifida.

Fetoscopy is usually performed in the second or third trimester of pregnancy. The procedure can place the fetus at increased risk of adverse outcomes, including fetal loss or preterm delivery, so the risks and benefits must be carefully weighed in order to protect the health of the mother and fetus(es). The procedure is typically performed in an operating room by an obstetrician-gynecologist.

History

In 1945, Björn Westin published a study which documented his use of a panendoscope to directly observe embryos. In 1966, Agüero et al. published a study which used hysteroscopy to observe various features of the fetus, cervix, and uterus. In 1972, Carlo Valenti of the SUNY Downstate Medical Center recorded a technique which he called "endoamnioscopy", which allowed for direct visualization of the developing fetus. Gallinat made the first attempt to standardize these techniques in 1978.

Because of the invasiveness of these procedures and the high risk they posed to the fetus, they were largely discarded in favor of transvaginal sonography until the 1990s. By that time, smaller instruments had been developed which reduced the risk to the fetus and provided a better visual for the physician. This in turn allowed for the development of techniques for surgical interventions such as biopsy. By 1993, authors such as Cullen, Ghirardini, and Reece had referred to this technique as "fetoscopy".

The field of minimally-invasive surgical fetoscopy has continued to develop since the 2000s. Physicians such as Michael Belfort and Ruben Quintero have used the technique to remove tumors and correct spina bifida on fetuses within the uterus.

Non-surgical fetoscopes

Fetoscopy is a surgical procedure which may involve the use of a fibreoptic device called a fetoscope. Some confusion may arise from the use of specialized forms of stethoscopes, including Pinard horns and Doppler wands, to audibly monitor fetal heart rate (FHR). These audio diagnostic tools are also called "fetoscopes" but are not related to visual fetoscopy.

Details

Fetoscope: A device used to obtain information about a fetus within the uterus. There are two types of fetoscopes: A fiberoptic scope for looking directly at the fetus within the uterus and a stethoscope designed for listening to the fetal heart beat.

What is the use of fetoscope?

The fetoscope projects an image onto a screen so your surgeon can view your baby and placenta. Depending on the type of surgery, your surgeon will insert surgical tools through the fetoscope to perform the procedure or collect tissue samples.

A fetoscopy is a procedure that allows your healthcare team to see the inside of your uterus during pregnancy. It helps treat certain genetic conditions in your unborn baby.

What is a fetoscopy?

Fetoscopy is a procedure during pregnancy that lets your pregnancy care provider see your unborn baby inside the womb (uterus). Providers use it to evaluate and treat congenital disorders (diseases you’re born with). It involves inserting a thin, fiber-optic tube (endoscope or fetoscope) into your uterus through a tiny incision in your abdomen. It has a small camera on the end so your provider can see inside your uterus and amniotic sac (the sac that holds your baby in your uterus). The fetoscope is hollow, so your provider can insert surgical tools through it, allowing them to treat certain fetal conditions or obtain samples of tissue (biopsy). In some cases, the fetoscope is inserted through your cervix instead of through your abdomen.

When is a fetoscopy done?

Fetoscopy is performed in the second or third trimester of pregnancy to treat fetal conditions or collect biopsies.

Some of the most common conditions treated with fetoscopy are:

* Twin-to-twin transfusion syndrome

Twin-to-twin transfusion syndrome is a rare, potentially life-threatening condition that occurs when identical twins aren't getting an equal share of blood while in the womb. Your surgeon uses a fetoscope to better visualize your placenta and the blood vessels causing the condition. Then, they place a laser through the fetoscope that they use to close off the blood vessels causing uneven blood flow. This procedure is called fetoscopic laser photocoagulation.

* Amniotic band syndrome

Amniotic band syndrome occurs when your baby gets tangled up in bands of tissue from the amniotic sac. It can restrict blood flow or cause amputation of limbs or organs. A fetoscope allows your surgeon to insert a laser device that cuts and releases the bands of tissue around your baby.

* Congenital diaphragmatic hernia (CDH)

CDH occurs when your baby has a hole in its diaphragm, which causes its abdominal organs to shift upwards, putting pressure on the lungs. This prevents their lungs from growing properly. Surgeons use fetoscopy to insert a balloon in your baby’s airway to promote lung growth. The balloon is removed several weeks later. This procedure is called fetoscopic endoluminal tracheal occlusion (FETO).

There are other conditions fetoscopy may be used for, such as treatment of placental tumors, spina bifida and other congenital diseases.

What’s the purpose of a fetoscopy?

The purpose of fetoscopy is to allow pregnancy care providers to assess and treat congenital conditions during pregnancy. In most cases, these are conditions that are life-threatening to your unborn baby. It’s performed when your baby’s provider needs to treat a disease or condition while they’re still in the womb.

What do I do to prepare for fetoscopy?

It depends on the extent of the procedure and if your healthcare provider plans to insert the fetoscope through your math or your abdomen. Other factors include how your provider will give you anesthesia (local or general) or if they give you other medications to decrease fetal movement during surgery. Your healthcare provider will discuss how you prepare for the procedure based on your situation.

How is fetoscopy performed?

Fetoscopy is typically performed in an operating room. Your provider may give you local anesthesia or sedative medication to reduce pain and prevent you and your unborn baby from moving during surgery.

Your surgeon follows these steps to perform the procedure:

* Your surgeon makes a small incision in your abdomen.
* Your surgeon inserts a fetoscope through the incision and into your uterus and amniotic sac.
* The fetoscope projects an image onto a screen so your surgeon can view your baby and placenta.
* Depending on the type of surgery, your surgeon will insert surgical tools through the fetoscope to perform the procedure or collect tissue samples.

If your surgeon performs the procedure through your cervix, they will first insert a speculum into your math. This duckbill-shaped device allows them to better see your cervix (the opening to your uterus) because it opens your vaginal wall. Then, they insert a fetoscope through your cervix and into your uterus.

Is a fetoscopy invasive?

Fetoscopy is minimally invasive. The alternative methods for fetal surgery involve making larger incisions in your abdomen near your uterus. These open abdominal procedures are more invasive and have higher risks of complications.

What are the risks of fetoscopy?

As with most surgeries, there are some risks to a fetoscopy, including:

* Preterm birth.
* Premature labor.
* Preterm premature rupture of membranes (your water breaks early).
* Loss of the pregnancy.
* Infection.
* Bleeding

What does fetoscopy tell you?

Surgeons use fetoscopy as a diagnostic and surgical tool, so it depends on why you’re having the procedure. Fetoscopy gives your baby’s healthcare provider important information on their condition. It also helps them treat conditions that may cause complications during the remainder of your pregnancy or delivery.

Some factors your provider considers after fetoscopy include:

* Type of delivery required: Your provider may decide a C-section is safest depending on your baby’s condition.
* Place of delivery: Depending on the condition, your provider will decide if special equipment or care is required during delivery.
* Timing of delivery: Your provider will decide if your pregnancy can continue or if early delivery is needed.

When do you know the results of fetoscopy?

It depends on the reason. The procedure itself isn’t a test. Rather, it’s a method providers use to evaluate and treat conditions in unborn babies. For example, if it’s performed to collect tissue, it will take a few days to get the test results. However, if your baby’s surgeon is using a laser to cut and seal irregular blood vessels, you’ll know after surgery if it was successful.

What is the recovery time after fetoscopy?

The surgery is minimally invasive, but it does take time to recover if an incision is made in your abdomen. Most people can return to normal activities the same day, being cautious around your abdominal or vaginal area. It’s best to discuss recovery instructions with your health care team based on your unique situation.

Fetoscopy lets your healthcare team diagnose, evaluate and treat congenital disorders while your baby is still in your womb. It’s typically performed after 18 weeks of pregnancy, when most birth disorders are found. It can be potentially life-saving when used to treat or correct certain diseases. Discuss your concerns about the procedure with your pregnancy care provider. It’s normal to be scared, but let your providers reassure you that fetoscopy is safe and that they’re doing everything they can to keep your baby healthy.

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#1 2023-06-08 00:14:34

Fetoscope

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