What are the indications for a fetoscopy?

Pregnancy can be scary for those experiencing it for the first time. Even in women that already have multiple pregnancies before, they sill still have worries or doubts if their baby would be fine. This shows that pregnancy on its own is always something that is unpredictable and best for the mother to get regular health screening to ensure a healthy pregnancy and a safe delivery. In this article, we will learn about fetoscopy, a procedure used in evaluating pregnancy.

Fetoscopy is an endoscopic procedure used during pregnancy to visualise the fetus. It is the direct visualisation of the amniotic cavity from the second trimester onwards. The optimal time for this procedure is 18 to 20 weeks of gestation. Fetoscopy is also used to provide means of obtaining fetal skin or liver biopsy. There are few indications where fetoscopy is performed, including:

  • Fetal inspection- to look for facial or limb defect syndrome
  • Fetal blood sampling- such as detecting haemophilia and thalassemia
  • Fetal skin biopsy- in cases such as lethal epidermolysis bullosa
  • Fetal liver biopsy- such as in cases of ornithine transcarbamylase deficiency
  • Surgery- frequently in case of severe congenital diaphragmatic hernia and myelomeningocele, also in twin-to-twin transfusion syndrome

Fetoscopy procedure is done by making a little incision on the abdomen. Fetoscope is then inserted through the abdominal wall and uterus into the amniotic cavity. The fetoscope will then produce an image onto the screen that allows the surgeon to be able to view both baby and placenta. Majority fetoscopy is done under local anaesthesia but in some cases may be done with epidural anaesthesia. Fetoscopy may also be inserted through the cervix into the uterus. In such cases, a speculum will be placed into the vagina to open the vaginal wall.

Fetoscopy is considered a minimally invasive procedure. It is an alternative method for fetal surgery which often requires large incisions in the abdomen to get access to the uterus. Fetal surgery can pose high risk and complications but it may be used in certain cases where fetoscopy is not feasible. Fetoscopy has been proved to lower the chances for preterm labour when compared to open fetal surgery in treating several fetal anomalies.

Despite fetoscopy seeming like one of the best procedures available to treat babies with anomalies, there are still possible risks that come with the procedure. Risks such as amniotic leakage, infection and fetal death are among risks that come with the procedure. However, the percentage of these risks are relatively low. When the procedure is done by experts, risks are almost to none. Furthermore, risk for fetoscopy is very low compared to open fetal surgery.

We can see that fetoscopy is made possible after decades of research and trials. Fetoscopy has made open surgery that used to cause so many problems to be minimised. It also means both mother and baby will have less health issues. Thankfully, with the more high-resolution obstetrical ultrasound and other prenatal screening plus diagnostic techniques, has offered the best chances and opportunity for healthcare professionals to understand fetal conditions. Imagine in the old days where it is difficult to detect fetal abnormalities, many parents are left with feeling disappointed or distressed knowing their baby is not in a healthy condition. Hence, we should be grateful that many devices and knowledge we now know has made it possible to treat a fetal as a patient.

In essence, fetoscopy is a procedure done on pregnant women to visualise the fetus. It is best done when pregnancy is in 18 to 20 weeks of gestation. There are few indications for fetoscopy, with twin-to-twin transfusion syndrome being the most common one. This procedure is considered minimally invasive and poses less risk or complications when compared to the previous open fetal surgery. Those who need to undergo fetoscopy need to understand that the procedure is done to help save the baby and provide the best health.

Since I have mentioned twin-to-twin transfusion syndrome, do you know any rough ideas of what this condition is about? This syndrome is a rare condition but once it happens it can be a life-threatening event. As the name implies, it is a condition that affects twins in the uterus. This syndrome is characterised by the identical twins sharing a placenta. With that being said, the blood flows and nutrients received is unequally between the twins. This condition occurs in 10 to 15 percent of monochorionic twins (twins that share a placenta) and diamniotic (two amniotic sacs) twins. Majority of twins with the syndrome survive and remain normal and healthy when appropriate treatment is given during pregnancy. When left untreated, the survival rate for the twins can be as low as 10% only. Fetoscopy usage in this syndrome is by coagulating the placental vessel which causes the syndrome. This procedure uses laser photocoagulation technique. It is often guided with ultrasound. Research shows that coagulation of the placental surface between the connecting vessel does provide the best outcome after laser surgery.

Also read – Dengure Prevention.

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