Fetoscopy is a minimally invasive surgical procedure performed on a fetus while still inside the uterus. It involves inserting a thin, camera-equipped tube, known as a fetoscope, through a small incision in the mother’s abdomen into the amniotic sac. This allows medical professionals to directly visualize the fetus, placenta, and umbilical cord, providing a less invasive alternative to traditional open fetal surgeries for various conditions.
Medical Conditions Addressed by Fetoscopy
Fetoscopy addresses complex conditions affecting fetal development, aiming to improve outcomes that might otherwise be less favorable if intervention waited until after birth.
Twin-to-Twin Transfusion Syndrome (TTTS) affects identical twins sharing a single placenta. In TTTS, abnormal blood vessel connections cause unequal blood sharing, leading one twin (the donor) to have too little blood and the other (the recipient) to have too much. Fetoscopic laser photocoagulation ablates these vessels, balancing blood flow and significantly improving survival rates for both twins.
Myelomeningocele, the most severe form of Spina Bifida, involves the spinal cord and nerves being exposed through an opening in the baby’s back. Prenatal fetoscopic repair aims to close this defect, protecting the spinal cord from further damage. Studies suggest that in-utero repair can reduce the need for shunts to drain fluid from the brain (hydrocephalus) and improve motor function and brain development compared to postnatal repair.
Fetoscopic Endoluminal Tracheal Occlusion (FETO) treats severe Congenital Diaphragmatic Hernia (CDH), a birth defect where a hole in the diaphragm allows abdominal organs to move into the chest, hindering lung development. During FETO, a balloon is temporarily placed in the fetal trachea to block lung fluid escape, increasing pressure within the lungs and stimulating their growth. This intervention can improve lung development and increase survival rates for babies with severe CDH.
The Surgical Procedure
The procedure begins with careful preparation of the mother, which may involve administering local or regional anesthesia and medications to relax the uterus and keep the fetus still. An ultrasound examination precisely locates the placenta and fetus, guiding the optimal entry point for the fetoscope.
A small incision is made on the mother’s abdomen. Through this incision, a thin tube called a trocar and cannula is inserted into the uterus and amniotic cavity, often under continuous ultrasound guidance to avoid the placenta. The fetoscope, a slender instrument equipped with a camera, is then passed through this tube, projecting a magnified image onto a screen.
Once the fetoscope provides a clear view, specialized instruments, such as laser fibers for ablating blood vessels in TTTS or tiny tools for closing spinal defects in myelomeningocele, are introduced through additional channels in the scope or through separate small ports. For conditions like CDH, a balloon is maneuvered into the fetal trachea and inflated. After the surgical steps are completed, all instruments are withdrawn, and the small incision is closed, allowing the pregnancy to continue.
Post-Procedure Care and Potential Complications
Following a fetoscopy procedure, maternal care focuses on monitoring and preventing complications to ensure the pregnancy continues safely. Mothers are typically monitored in the hospital for a period, often overnight, for signs of preterm labor or other issues. Medications may be prescribed to prevent uterine contractions and reduce the risk of preterm delivery, and patients are usually advised to limit physical activity, including bed rest.
Despite being minimally invasive, fetoscopy carries potential risks for both the mother and the fetus. The most common complications include premature rupture of membranes (PPROM), where the amniotic sac breaks before labor begins, and preterm labor. These complications can lead to an early delivery, which may result in health challenges for the newborn associated with prematurity.
There is also a risk of infection, although this is closely monitored and managed with preventative measures. Other complications could include bleeding, placental abruption, or injury to the uterus or fetus. The medical team provides close follow-up care, including regular ultrasounds, to monitor the fetus’s progress and detect any complications early.