What is a Fetoscopy?
Fetoscopy is a technique that utilizes a small camera or scope to examine and perform procedures on the fetus during pregnancy. The scope is introduced through a small incision on the mother's abdomen and placed into the amntiotic sac through the uterus. This allows a visual assessment of any abnormalities during pregnancy. Fetoscopy is used for several different diseases and has been used to perform surgical procedures and collecting biopsies.
Which conditions are treated with Fetoscopy?
Historically, fetoscopy has been utilized for many different fetal conditions. However, only three disease conditions routinely utilize this technique.
- Twin-Twin Transfusion Syndrome - A fetoscope is utilized to provide a visualization of the abnormal blood vessels between twins that cause this disease. The scope also allows the placement of the laser device which is utilized to disconnect abnormal blood vessel connections
- Amniotic Band Syndrome - Fetoscopy allows visualization of the abnormal bands of tissue from the amniotic membrane which are stuck to the fetus. These bands can cause strictures or amputations of vital organs and limbs. The scope allows the ability to release the bands.
- Congenital Diaphragmatic Hernia - A potential fetal therapy for CDH is the placement of a balloon in the trachea that promotes lung growth. This technique requires fetoscopy to visualize the fetal airway (trachea). Balloon occlusion for CDH remains experimental and is under clinical investigation at this point. This therapy is currently undergoing clinical trials.
Please keep in mind that fetoscopy is a rarely utilized procedure and for each patient diagnosed with any of the above conditions, only a few will need fetal intervention. The recommendation to perform fetal intervention and fetoscopy will be determined by your team of doctors at the Center and discussed with you.
What special considerations should be made at time of delivery?
Type of delivery - If all goes well with the fetoscopic intervention, your pregnancy will be allowed to progress to term and depending on the condition, delivery usually does not require a Cesarean delivery. The need for this fetal intervention should not impact your type of delivery. The delivery plan should be carefully discussed between the mother and the obstetrician.
Place of delivery - Depending on the condition, your baby may or may not need special medical care after birth. If all the prenatal monitoring suggests that your baby is doing well, the baby can be delivered at the hospital of your choice. However, the hospital should be prepared to handle any intensive care of your newborn and have a neonatal intensive care unit with the capability to provide specialized care.
Time of delivery - There is no reason to intentionally induce early delivery. After the fetoscopic procedure, your pregnancy will be closely monitored. The team at the Center may recommend early delivery for pregnancies that appear to be in danger.
What will happen at the Fetoscopy procedure?
The entire team will carefully plan for the fetoscopy procedure with preparation to handle all potential complications. Generally, the procedure is performed under sedation and local anesthesia. Your doctors will repeat a detailed ultrasound to confirm the problem and identify the abnormalties. A small skin incision is made to allow the placement of the scope. Once inside the amniotic sac, your doctors will perform the necessary procedure. On occasion, the fetoscopy procedure cannot be performed with a small skin incision due to the location of the fetuses and placenta in the uterus. In these situations, the procedure requires a larger incision to expose the uterus in order to provide a safe window for the scope.
The fetoscopy procedure is performed in the operating room with all the special equipment necessary to ensure the safety of you and your baby. Afterwards, the mother will be admitted to the Women's Center to monitor for preterm labor and complications at Children's Memorial Hermann Hospital.
What are the risks and considerations?
The major risk of fetoscopy is injuring and losing the fetus during the procedure. The risks and benefits of the procedure will be carefully explained. If all goes well with the procedure, your pregnancy will be carefully monitored for preterm labor and premature delivery.
Contact the Texas Fetal Center to make an appointment with a high-risk pregnancy doctor.