Partial Amniotic Carbon Dioxide Insufflation During Minimally Invasive Fetoscopic Interventions Seems Safe for the Fetal Brain in Sheep

Kohl, Thomas; Ziemann, M; Weinbach, Julia; Tchatcheva, K.; Gembruch, Ulrich; Hasselblatt, Martin

doi:10.1089/lap.2010.0068

Cited by 26 publications

(25 citation statements)

References 8 publications

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“…Significant risks include preterm labor and delivery, need for maternal transfusion, separation of chorioamniotic membranes, chorioamnionitis, and longer hospitalization [14,30] . The presence of hydrops increases morbidity and mortality of fetal intervention [28] .…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic Risk Stratification of Fetuses with Sacrococcygeal Teratoma and Twin-Reversed Arterial Perfusion

Byrne

Lee

Kipps³

et al. 2011

Fetal Diagn Ther

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Objective: To evaluate pre-intervention echocardiographic parameters of cardiac function in fetuses who survive without hydrops as compared to fetuses who develop hydrops or perinatal death in the setting of sacrococcygeal teratoma (SCT) and twin-reversed arterial perfusion sequence (TRAP). Methods: Clinical, echocardiographic and sonographic data of fetuses with SCT or TRAP during 1999–2009 were reviewed retrospectively. Measurements of cardiothoracic ratio (CTR), cardiac dimension Z-scores, combined ventricular output (CVO), valvular regurgitation, and cardiovascular profile scores (CVPS) were obtained. Results: In total, 19 fetuses (11 SCT, 8 TRAP) met the inclusion criteria and 26 detailed fetal echocardiographic studies were reviewed. Outcome was poor in 7 pregnancies (group A) and good in 12 (group B). Group A had worse CVPS (8.5 vs. 10, p < 0.01) and higher CTR (0.37 vs. 0.30, p = 0.04). At least one of the following was present in each group A fetus: CTR >0.5, CVO >550 ml/min/kg, tricuspid or mitral regurgitation, or mitral valve Z-score >2. No group B fetus had any of these abnormalities. No fetus in either group had abnormal venous Doppler waveforms at presentation. Conclusions: Fetal echocardiography can identify abnormalities of cardiac size and systolic, but not diastolic, function in all fetuses who subsequently died or developed hydrops.

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Section: Discussionmentioning

confidence: 99%

Echocardiographic Risk Stratification of Fetuses with Sacrococcygeal Teratoma and Twin-Reversed Arterial Perfusion

Byrne

Lee

Kipps³

et al. 2011

Fetal Diagn Ther

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“…An important progress for endoscopic approach was the implementation of single-layer repair and biocellulose patch for defect closure, pioneered by groups in Brazil and Germany, respectively. These novel approaches allowed for a satisfactorily protection of the herniated neural tissue, and obviated the need to perform standard triple layer repair through an endoscopy [51][52][53] . The most recent published experiences from the CECAM trial demonstrated a significant improvement in outcomes according to the growing experiences [54] .…”

Section: Appropriate Training For In Utero Repair Of MMCmentioning

confidence: 99%

Establishing Prenatal Surgery for Myelomeningocele in Asia: The Singapore Consensus

et al. 2017

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Objectives: The Management of Myelomeningocele Study (MOMS Trial) has inspired many fetal therapy centers (FTCs) to offer open fetal surgery for myelomeningocele (MMC). This is an initial effort to create a candidate model that can be applicable to many parts of Asia. Material and Methods: A limited selection of specialists from 4 established FTCs in Thailand, Hong Kong, India, and Singapore met for a round table discussion. Experts from Children's Hospital of Philadelphia (CHOP) involved in the Trial moderated the session. The practice suggestions in this statement were from a targeted literature review and expert opinion. Results: A high prevalence of MMC in Asia supports an effort to adopt the procedure, but only in established FTCs with good maternal and neonatal ancillary supports. The falling incidence of MMCs may affect case volume and maintenance of skill. A regional approach was recommended. Fetal benefits have to be weighed against maternal risks, with a consideration of recent outcome data from the endoscopic approach. Responsible FTCs need standardized diagnosis and management, with their long-term outcome data available for an audit. Conclusions: It is envisaged that the information presented by this multidisciplinary team would be useful for FTCs in Asia or elsewhere that plan to establish more advanced fetal care in the future.

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“…It is reassuring that, in our clinical experience of almost 150 human fetuses, no significant direct ill effects on the fetal brain or on postnatal neurological development of treated children could be attributed to the use of PACI in mid-gestation. Further evidence pointing to its safe clinical application stems from a study in sheep that did not show any postnatal neurological and brain histological abnormalities after PACI 11 . Yet, given the early clinical experience with PACI, continued caution, flow studies and assessments of clinical outcomes in a larger number of patients are desired.…”

Section: Impact Of Partial Amniotic Carbon Dioxide Insufflation (Pacimentioning

confidence: 99%

Impact of partial amniotic carbon dioxide insufflation (PACI) on middle cerebral artery blood flow in mid‐gestation human fetuses undergoing fetoscopic surgery for spina bifida aperta

Kohl¹

2016

Ultrasound in Obstet & Gyne

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Partial Amniotic Carbon Dioxide Insufflation During Minimally Invasive Fetoscopic Interventions Seems Safe for the Fetal Brain in Sheep

Abstract: The application of PACI during minimally invasive fetoscopic interventions seems safe for the fetal brain. Due to the still limited clinical experience with PACI, continued assessment of its maternal and fetal risks as well as management are required.

Cited by 26 publications

References 8 publications

Echocardiographic Risk Stratification of Fetuses with Sacrococcygeal Teratoma and Twin-Reversed Arterial Perfusion

Echocardiographic Risk Stratification of Fetuses with Sacrococcygeal Teratoma and Twin-Reversed Arterial Perfusion

Establishing Prenatal Surgery for Myelomeningocele in Asia: The Singapore Consensus

Impact of partial amniotic carbon dioxide insufflation (PACI) on middle cerebral artery blood flow in mid‐gestation human fetuses undergoing fetoscopic surgery for spina bifida aperta

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