Obstetrical endoscopy

Abstract

Fetoscopy has been reintroduced in fetal diagnosis and therapy, as a result of instrumental innovations. It has been suggested that fetoscopy be used to guide endoscopic operations on the fetus, but this application is still in the experimental phase. Its use for surgical interventions on the placenta, umbilical cord, and to a lesser extent the fetal membranes, could be called 'obstetrical' endoscopy. Nd:YAG laser coagulation of chorionic plate vessels for feto-fetal transfusion syndrome is the most common operation carried out today. Survival rates of 60% or more have recently been reported on both sides of the Atlantic Ocean. Neurological morbidity does not exceed 6%, which compares favorably with serial amnioreductions and may become the most important incentive for performing the operation. A randomized trial comparing both therapies as a next step is being proposed. Fetoscopy has also been used for cord ligation, but because of the complexity of the operation and the high risk for preterm prelabor rupture of the membranes, other alternatives have been investigated. Most experience has been gathered with bipolar cord occlusion, a procedure which can be performed under ultrasound guidance. The instrumental considerations and potential complications of fetoscopy are discussed.