Fetoscopy is an endoscopic procedure during

pregnancy Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ca ...

to allow surgical access to the

fetus A fetus or foetus (; plural fetuses, feti, foetuses, or foeti) is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal deve ...

, the

amniotic cavity The amniotic sac, also called the bag of waters or the membranes, is the sac in which the embryo and later fetus develops in amniotes. It is a thin but tough transparent pair of membranes that hold a developing embryo (and later fetus) until shor ...

, the

umbilical cord In placental mammals, the umbilical cord (also called the navel string, birth cord or ''funiculus umbilicalis'') is a conduit between the developing embryo or fetus and the placenta. During prenatal development, the umbilical cord is physiologic ...

, and the fetal side of the

placenta The placenta is a temporary embryonic and later fetal organ that begins developing from the blastocyst shortly after implantation. It plays critical roles in facilitating nutrient, gas and waste exchange between the physically separate mater ...

. A small (3–4 mm) incision is made in the

abdomen The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the torso. ...

, and an

endoscope An endoscope is an inspection instrument composed of image sensor, optical lens, light source and mechanical device, which is used to look deep into the body by way of openings such as the mouth or anus. A typical endoscope applies several modern t ...

is inserted through the

abdominal wall In anatomy, the abdominal wall represents the boundaries of the abdominal cavity. The abdominal wall is split into the anterolateral and posterior walls. There is a common set of layers covering and forming all the walls: the deepest being the v ...

and

uterus The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The uter ...

into the amniotic cavity. Fetoscopy allows for medical interventions such as a

biopsy A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a diseas ...

(tissue sample) or a

laser A laser is a device that emits light through a process of optical amplification based on the stimulated emission of electromagnetic radiation. The word "laser" is an acronym for "light amplification by stimulated emission of radiation". The fir ...

occlusion of abnormal blood vessels (such as

chorioangioma Chorioangioma, or chorangioma, is a benign tumor of placenta. It is a hamartoma-like growth in the placenta consisting of blood vessels, and is seen in approximately 0.5 to 1% pregnancies. It is mostly diagnosed ultrasonically in the second trim ...

) or the treatment of

spina bifida Spina bifida (Latin for 'split spine'; SB) is a birth defect in which there is incomplete closing of the spine and the membranes around the spinal cord during early development in pregnancy. There are three main types: spina bifida occulta, me ...

. Fetoscopy is usually performed in the second or third trimester of pregnancy. The procedure can place the fetus at increased risk of adverse outcomes, including fetal loss or preterm delivery, so the risks and benefits must be carefully weighed in order to protect the health of the mother and fetus(es). The procedure is typically performed in an

operating room Operation or Operations may refer to: Arts, entertainment and media * ''Operation'' (game), a battery-operated board game that challenges dexterity * Operation (music), a term used in musical set theory * ''Operations'' (magazine), Multi-Man ...

by an

obstetrician-gynecologist Obstetrics and Gynaecology (also spelled as Obstetrics and Gynecology; abbreviated as Obs and Gynae, O&G, OB-GYN and OB/GYN) is the medical specialty that encompasses the two subspecialties of obstetrics (covering pregnancy, childbirth, and ...

History

In 1945, Björn Westin published a study which documented his use of a panendoscope to directly observe embryos. In 1966, Agüero et al. published a study which used

hysteroscopy Hysteroscopy is the inspection of the uterine cavity by endoscopy with access through the cervix. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention (operative hysteroscopy). Hysteroscope A hyst ...

to observe various features of the fetus, cervix, and uterus. In 1972, Carlo Valenti of the

SUNY Downstate Medical Center SUNY Downstate Health Sciences University (Downstate) is a public medical school and hospital in Brooklyn, New York. It is the southernmost member of the State University of New York (SUNY) system and the only academic medical center for hea ...

recorded a technique which he called "endoamnioscopy", which allowed for direct visualization of the developing fetus. Gallinat made the first attempt to standardize these techniques in 1978. Because of the invasiveness of these procedures and the high risk they posed to the fetus, they were largely discarded in favor of transvaginal sonography until the 1990s. By that time, smaller instruments had been developed which reduced the risk to the fetus and provided a better visual for the physician. This in turn allowed for the development of techniques for surgical interventions such as biopsy. By 1993, authors such as Cullen, Ghirardini, and Reece had referred to this technique as "fetoscopy". The field of minimally-invasive surgical fetoscopy has continued to develop since the 2000s. Physicians such as Michael Belfort and Ruben Quintero have used the technique to remove tumors and correct

on fetuses within the uterus.

Non-surgical fetoscopes

Fetoscopy is a surgical procedure which may involve the use of a fibreoptic device called a fetoscope. Some confusion may arise from the use of specialized forms of

stethoscope The stethoscope is a medical device for auscultation, or listening to internal sounds of an animal or human body. It typically has a small disc-shaped resonator that is placed against the skin, and one or two tubes connected to two earpieces. ...

s, including

Pinard horn A Pinard horn is a type of stethoscope used to listen to the heart rate of a fetus during pregnancy. It is a hollow horn, often made of wood or metal, about long. It functions similarly to an ear trumpet by amplifying sound. The user holds the wi ...

s and Doppler wands, to audibly monitor fetal heart rate (FHR). These audio diagnostic tools are also called "fetoscopes" but are not related to visual fetoscopy.

References

External links

What is fetal therapy?
{{Endoscopy Obstetric surgery Medical equipment Endoscopy Tests during pregnancy

History

Non-surgical fetoscopes

See also

References

External links