Fetoscopy

Fetoscopy is indicated for any woman who is at risk for delivery of a baby with a significant birth defect. It is used also to perform corrective surgery on the fetus when possible.

 

Fetoscopy is an endoscopic procedure that allows direct visualization of the fetus via the insertion of a tiny, telescope-like instrument through the abdominal wall and into the uterine cavity. Direct visualization may lead to diagnosis of a severe malformation, such as a neural tube defect. During the procedure, fetal blood samples to detect congenital blood disorders (e.g., hemophilia, sickle cell anemia) can be drawn from a blood vessel in the umbilical cord for biochemical analysis. Fetal skin biopsies also can be done to detect primary skin disorders. Fetoscopic surgery (placement of central nervous system [CNS] shunts, etc.) is becoming more and more a reality.

 

Fetoscopy is performed at approximately 18 weeks’ gestation. At this time the vessels of the placental surface are of adequate size and the fetal parts are readily identifiable. A therapeutic abortion would not be as hazardous at this time as it would be if it were done later in the pregnancy. An ultrasound examination is usually performed the day after the procedure to confirm the adequacy of the amniotic fluid and fetal viability.

 

 

 

Fetoscopy Complications

Fetoscopy may lead to any of the following complications:

  • Spontaneous Abortion.
  • Premature Delivery.
  • Amniotic Fluid leak.
  • Intrauterine Fetal Death.
  • Amnionitis.

 

 

 

How is Fetoscopy Performed?

Fetoscopy is performed by an Obstetrician. The procedure may take 1 to 2 hours.

  • The Fetal Heart Rate (FHR) is measured before the test to serve as a baseline value.
  • If meperidine (Demerol) is ordered, it should be administered before the test because it crosses the placenta and quiets the fetus. This prevents excessive fetal movement, which would make the procedure more difficult.
  • The mother is placed in the supine position on an examining table.
  • The abdominal wall is anesthetized locally.
  • Ultrasonography is performed to locate the fetus and the placenta and to identify a safe area to penetrate the uterus.
  • The endoscope is inserted.
  • Biopsy specimens and blood samples may be obtained. • Note that this procedure is performed by a physician in 1 to 2 hours.
  • The Fetal Heart Rate is measured again after the test to be compared with the baseline value in order to detect any side effects related to the procedure.
  • The mother and fetus need to be carefully monitored after the procedure for alterations in blood pressure, pulse rate, uterine activity, and fetal activity; vaginal bleeding; and loss of amniotic fluid.
  • For mothers who are Rh negative, RhoGAM is administered unless the fetal blood is found to be Rh negative.
  • Antibiotics may be administered prophylactically after the test to prevent amnionitis.
  • The mother must avoid strenuous activity for 1 to 2 weeks following the procedure and report any pain, bleeding, amniotic fluid loss, or fever.

 

 

 

Findings of Fetoscopy

The following conditions may be detected using Fetoscopy:

Developmental Defects (e.g., Neural Tube Defects): These defects are visible on a fetus exceeding 20 weeks in age.

 

Congenital Blood Disorders (e.g., Hemophilia, Sickle Cell Anemia): These congenital abnormalities are identified by evaluation of the fetal blood.

 

Primary Skin Disorders: These may be obvious at the time of fetoscopy. Skin biopsies can be performed as well.