ABSTRACT
BACKGROUND: Prenatal ultrasound study allows the detection of fetal malformations. Intrauterine interventions are now contemplated to correct, or interfere with, the natural history of these anomalies. Minimally invasive techniques, such as the so-called "Fetendo" (fetal endoscopy), are now therapeutic possibilities. METHODS: From 2002 to 2007, 205 fetoscopies were performed in our hospital's fetal surgery program. Fetoscopic interventions were carried out under epidural anesthesia, accessing the uterine cavity with a fetoscope containing a 1.2-mm telescope. Following ultrasound-guided needle puncture of the amniotic cavity, the fetoscope was inserted through a 3-mm sheath by the Seldinger technique. Visibility was maintained with an amnioinfusion system. This procedure offers access to the placental surface, umbilical cord, and fetus. RESULTS: Fetoscopy was used to perform laser coagulation of communicant placental vessels in 148 biamniotic monochorionic gestations with twin-to-twin transfusion syndrome (TTTS) and to occlude the umbilical cord in 32 cases of discordant monochorionic twins with a severe or lethal anomaly in one of the fetuses, and 5 cases of reversed arterial perfusion (TRAP) sequence. In addition, fetoscopy was performed in 18 cases to treat severe congenital diaphragmatic hernia by tracheal occlusion with an endotracheal balloon. Finally, in 2 cases, fetoscopic release of amniotic bands was performed to rescue extremities and the umbilical cord. The most common complications (10%) were preterm rupture of membranes, which resulted in preterm delivery. Other indications for fetoscopy, which we are currently using in experimental animal models, include low urinary tract obstruction, sacrococcygeal teratoma, and repair of myelomeningocele defects. CONCLUSIONS: Fetoscopy can lower the incidence of preterm labor that occurs in response to the aggression of open surgery. At present, fetoscopy is effective for treating several fetal anomalies. Preterm rupture of membranes remains the weak link of fetoscopy. Refinement of the technique and technologic advances will help this problem and allow the use of fetoscopy for other pathologies in the future.
Subject(s)
Congenital Abnormalities/surgery , Fetofetal Transfusion/surgery , Fetoscopy/methods , Female , Humans , Pregnancy , Pregnancy Outcome , Treatment OutcomeABSTRACT
Objetivo: Estudiar el grado de aceptación de la amniocentesis y sus diferencias en función de la indicación entre las pacientes con riesgo secundario a la edad y riesgo secundario al cribado bioquímico. Métodos: Se incluyó a las gestantes referidas a la unidad de diagnóstico prenatal para estudio de cariotipo fetal durante un período de 7 años. Las pacientes fueron clasificadas en dos grupos según la indicación: grupo I (edad) y grupo II (cribado indicativo). Resultados: Se incluyó a 9.227 mujeres: 4.859 con la indicación de edad materna y 4.368 con indicación por cribado bioquímico. Rechazaron la amniocentesis 176 gestantes en el grupo I (el 3,62 per cent; intervalo de confianza (IC) del 95 per cent, 3,35-3,89 per cent) y 152 mujeres en el grupo II (el 3,48 per cent; IC del 95 per cent, 3,32-3,75 per cent). Tras un período de reflexión, reconsideraron su decisión 21 pacientes en el grupo I (12 per cent) y 22 en el grupo II (14 per cent). Conclusiones: La tasa de aceptación de la amniocentesis en nuestro centro fue del 96,92 per cent (IC del 95 per cent: 96,74-97,1 per cent). (AU)
