A fetoscope is a specialized medical instrument that allows direct visualization and sometimes treatment of a fetus within the womb during pregnancy. It plays a role in advanced prenatal care, offering a clear view where other imaging methods might not provide sufficient detail. This direct visual access aids medical professionals in assessing fetal development and addressing certain conditions before birth.
What is a Fetoscope?
A fetoscope is a thin, fiber-optic tube equipped with a light source and a lens or camera at its tip. This endoscope is designed to be inserted into the uterus for detailed viewing of the fetus and placenta. Unlike an ultrasound, which uses sound waves, a fetoscope provides a direct, real-time visual image of the developing baby.
The instrument allows observation of the fetus and its surrounding environment, including the amniotic sac and umbilical cord. Some fetoscopes are hollow, enabling the insertion of tiny surgical tools for collecting tissue samples. This direct visual feedback guides fetal interventions and aids in diagnosis.
How Fetoscopy is Performed
Fetoscopy is a minimally invasive procedure, typically performed in an operating room under local anesthesia, sometimes with additional sedation. The process begins with an ultrasound to pinpoint the fetus’s position and the placenta, guiding the medical team to the optimal insertion site. A small incision, usually 3 to 4 millimeters, is made in the mother’s abdomen.
Through this incision, the thin fetoscope is inserted into the uterus and amniotic sac. The camera transmits images to a monitor, allowing observation of the fetus and its surroundings. Depending on the procedure’s purpose, micro-instruments can be passed through the fetoscope to perform actions like taking biopsies or conducting laser treatments. After the procedure, the fetoscope is removed, and the incision is closed.
Reasons for Using a Fetoscope
A fetoscope is employed for specific medical indications where direct visualization or intervention within the uterus is necessary. One primary use involves diagnosing fetal anomalies not fully discernible through ultrasound alone, such as structural abnormalities or genetic conditions. It also aids in assessing fetal development and guiding precise interventions.
A common therapeutic application is in cases of twin-to-twin transfusion syndrome (TTTS), a condition in monochorionic twin pregnancies where blood flow is unevenly shared between the fetuses. Using the fetoscope, a laser can seal off connecting blood vessels on the placenta, balancing the blood supply. Fetoscopy can also treat conditions like amniotic band syndrome, where constricting tissue bands are released, or congenital diaphragmatic hernia, by placing a balloon to promote lung growth.
The Journey of Fetoscopy
The concept of directly viewing the fetus evolved from early explorations to modern procedures. In 1945, Björn Westin documented using a panendoscope to observe embryos, marking an early step in fetal visualization. Subsequent developments in the 1960s and 1970s, including Carlo Valenti’s “endoamnioscopy” in 1972, further advanced the technique for direct fetal observation.
Early fetoscopes were more rigid and posed higher risks, leading to a decline in their use as ultrasound technology improved. However, the 1990s witnessed a resurgence with the development of smaller, more flexible fiber-optic instruments and advanced video-endoscopy. This technological progress enhanced safety and efficacy, allowing for complex interventions like fetoscopic laser photocoagulation for TTTS. Today, fetoscopy continues to evolve with innovations in imaging and instrumentation, enabling more precise and less invasive fetal therapies.