Fetal blood‐gas values during fetoscopic myelomeningocele repair performed under carbon dioxide insufflation

Baschat, Ahmet; Ahn, Edward S.; Murphy, Jamie D.; Miller, Jena L.

doi:10.1002/uog.19083

Cited by 41 publications

(57 citation statements)

References 15 publications

(25 reference statements)

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“…As such placental gaseous exchange may be impaired more in sheep than in humans. This is consistent with a recent preliminary case series of three fetuses undergoing fetoscopic MMC repair using PACI suggesting that fetal hypercapnia in humans may not be as severe as described in animal models . However, in that study, umbilical vein blood samples were collected at an undefined interval after desufflation and so any intraoperative acid‐base disturbances may have been missed as CO 2 is highly soluble.…”

Section: Discussionsupporting

confidence: 89%

The effects of partial amniotic carbon dioxide insufflation in an ovine model

et al. 2018

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What's already known about this topic? PACI enables fetoscopic myelomeningocele repair as a minimally invasive alternative to open fetal surgery. PACI causes fetal hypercapnia and acidosis in sheep. Initial clinical series of fetoscopic myelomeningocele repair using PACI was associated with high rates of PPROM and preterm birth. What does this study add? Increasing PACI pressures results in larger disturbances in fetal acid‐base and uterine blood flow. Unheated, nonhumidified PACI exposure leads to fetal membrane inflammation. Important differences in sheep and human uterine and placental structure must be considered in our study interpretation.

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Section: Discussionsupporting

confidence: 89%

The effects of partial amniotic carbon dioxide insufflation in an ovine model

et al. 2018

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“…Safety concerns have been raised due to the observed association between CO 2 gas exposure and fetal acidosis and hypercarbia in animal model experiments . Recently, data obtained from three human fetuses during fetoscopic MMC repair have shown for the first time how in contrast to sheep experiments, CO 2 uterine insufflation does not cause fetal acidemia . Moreover, concerns have been raised about the effects of CO 2 on the fetoplacental membranes .…”

Section: Introductionmentioning

confidence: 99%

Amniotic membrane and placental histopathological findings after open and fetoscopic prenatal neural tube defect repair

et al. 2019

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Objectives To describe and compare placental and amniotic histology in women who underwent a fetoscopic myelomeningocele repair to those who underwent an open hysterotomy myelomeningocele repair. Also, we intended to compare findings from both prenatal repair groups to age‐matched control pregnant patients. Methods Placental and membrane histopathology from 43 prenatally repaired spina bifida cases (17 fetoscopic and 26 open) and 18 healthy controls were retrospectively assessed. Quantitative assessment of histopathology included apoptosis count and maternal and fetal underperfusion scores. Qualitative assessment included the detection of pigmented macrophages and/or signs of placental/amniotic inflammation. Associations between the duration of surgery or the duration of CO2 insufflation and quantitative histological parameters were tested. Results Fetoscopic surgery cases did not show significant differences in any of the studied parameters when compared against controls. No differences were detected either when compared with open repaired cases, except for lower proportion of pigmented laden macrophages in the fetoscopic group (11.8% vs 61.5%, P < 0.01). No associations between the duration of surgery or the duration of CO2 exposure and any of the quantitative histological parameters were detected. Conclusions These preliminary results support the lack of detrimental effects of the use of heated and humidified CO2 gas for uterine insufflation to fetal membranes and placenta.

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“…However, in this study, umbilical vein blood samples were collected after PACI, during the recovery phase. Interestingly, the pH reduction was least in the fetus exposed to heated‐humidified PACI . This could be explained by reduced fetal CO 2 absorption because of lower CO 2 solubility at higher temperatures and reduced CO 2 partial pressures because of higher water vapor pressures …”

Section: Fetal Surgery For Myelomeningocelementioning

confidence: 99%

Partial amniotic carbon dioxide insufflation for fetal surgery

et al. 2018

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Partial amniotic carbon dioxide insufflation (PACI) involves insufflating the amniotic sac with carbon dioxide (CO2) and, in some cases, draining some of the amniotic fluid. The creation of a gaseous intra‐amniotic compartment improves visualization, even in the presence of limited bleeding, and creates the work space required for complex fetoscopic procedures. Clinically, PACI is mostly used to perform fetoscopic myelomeningocele (MMC) repair, enabling a minimally invasive alternative to open fetal surgery. However, evidence of the fetal safety of PACI is limited. Previous animal experiments in sheep demonstrate that PACI induces fetal hypercapnia and acidosis with largely unknown short and longer term implications. In this review, we examine the literature for the physiological effects of intrauterine insufflation pressure, duration, humidity, and the role of maternal hyperventilation on fetal physiology and well‐being.

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Fetal blood‐gas values during fetoscopic myelomeningocele repair performed under carbon dioxide insufflation

Cited by 41 publications

References 15 publications

The effects of partial amniotic carbon dioxide insufflation in an ovine model

The effects of partial amniotic carbon dioxide insufflation in an ovine model

Amniotic membrane and placental histopathological findings after open and fetoscopic prenatal neural tube defect repair

Partial amniotic carbon dioxide insufflation for fetal surgery

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