Evaluation of Fetoscopy Role in Fetal Surgery and Fetal Medicine

Abstract

Introduction: This study aimed to evaluate, discuss and illustrate the role of fetoscopy diagnostically and therapeutically. Material and Methods: This study was conducted in private center in under the supervision of the professors of Azhar University, Egypt from Dec-2012 to Mar-2017. Women with confirmed fetal congenital malformations, and willing to do fetoscopy were recruited. Fetoscopy was attempted in all cases to treat the underlying fetal conditions. Follow up was made until delivery. Results: Twenty patients with 22 fetuses were included in this study with different congenital anomalies. Therapeutic drainage or coagulation was made in all cases. In cases of lower urinary tract obstruction, fetoscopy confirmed pre-suspected urethral atresia and changed the diagnosis from complete PUV to urethral atresia in some cases. The procedure succeeded in all cases. However, the ongoing success rate was 17 (77.3%) of fetuses. The overall number of live birth was 11 fetuses (50%). Overall, 15 (75%) of the 20 patients experienced some complication withpreterm labor the most prevalent 15 (75%). Conclusion: Fetoscopy can diagnose and differentiate between posterior urethral valve (PUV) and atresia, and manage well-selected cases of twin to twin transfusion syndrome (TTTS), and have a reasonable survival rate in lower urinary tract obstruction (LUTO).

Fetoscopy Role in Fetal Surgery and Fetal Medicine

“…The drainage of the bladder to the amniotic fluid was successful by fulguration and flushing in all cases. Successful management of PUV cases has been reported in other studies [14] [18] [19] [20] [21]. In those cases of PUV, the earlier the intervention, the better is the prognosis because the mega-bladder may lead to compression of the heart.…”

“…Since establishing the first program for fetoscopy for fetal blood sampling in 1981, another study in 2015 was conducted to evaluate the laser coagulation for severe TTTS in one center in UAE. Then, a third study, which considered the first trial to evaluate the role of fetoscopy in different types of congenital anomalies, was conducted in a private center in Cairo, Egypt, upon twenty patients with 22 fetuses [12] [13] [14]. Added to the previous data, in our country Egypt, congenital anomalies are highly prevalent [15] [16].…”