Fetus Surgeries Case Study

Merei Zhakanova

Extra credit

Write a report on fetus surgeries, including potential (nonexisting) applications. Until the last few decades there were only few possibilities available for the parents in case fetus has been diagnosed with a congenital malformation. They include the following: termination of pregnancy, change in mode, timing or place of delivery and continuation of pregnancy till term with vaginal of Cesarean delivery. Nevertheless, new options have appeared recently, comprising fetal therapy by non-operative methods and fetal surgical intervention. Open fetal surgery has effectively treated a great number of congenital malformations, which have morbid or life-threatening consequences, such as urinary tract obstruction, congenital

In order to improve the minimal access fetal surgery technique the following requirements should be met: existing pediatric and obstetric endoscopic techniques need to be modified, novel fetoscopic instruments should be developed, and also it is necessary to use a multidisciplinary team approach. Several obstacles were met during the development of the technique. The issue of poor visualization in turbid amniotic fluid is one of them was solved via pump driven fluid exchanger, which replaces amniotic fluid with saline in the course of operating, and that exchanged fluid is kept at physiological temperature in order to eliminate fetal hypothermia with fluid exchange. Also lack of fetal monitoring was resolved by inventing the ultrasonographic monitoring and lack of fetal analgesia was set via intramuscular fetal needle puncture with an analgesic. Mobile fetus was fixed by fetal suture fixation techniques and ultrasound directed trocar entry with the knowledge of fetal position. Intentionally designed diamond tipped needle, which is able to cut precisely membranes on entry has solved the problem of tenting and separation of chorioamniotic membranes with trocar insertion. One of the most issues arising, uterine bleeding during trocar insertion was solved by radially expanding access devices, which outwardly compresses the uterine vessels and secures the trocar in

One of them is congenital diaphragmatic hernia (CDH). In this defect abdominal viscera herniate into thorax via the posterolateral opening in the diaphragm. First CDH used to be fixed by open fetal surgery, during which hysterotomy was done to repair diaphragm directly. However, the techniques to obstruct fetal trachea have developed rather quickly. Nowadays endoluminal approach is applied. It uses detachable silicone balloons, self-expanding umbrellas and foam plugs. The risks of neck and tracheal dissection and laryngeal nerve injury are avoided by using this method. Also fetal tumors, like sacrococcygeal teratoma and congenital cystic adenomatoid malformation (CCAM) of the lung, were previously removed with open fetal surgery, but currently minimal access instruments are used to disturb blood flow or to lyse fetal tumors to slow their growth. Obstructive uropathy occurs rather frequently (1 in 1000 live births). Prenatal intervention with vescioamniotic shunts is used to bypass or directly treat the obstruction to restore the amniotic fluid to normal levels. Amniotic band syndrome may result in amputations, constrictions and postural deformities secondary to immobilization. This abnormality is caused by the early rupture of the amnion and mesodermic bands originating from the chorionic side of the amnion and inserting on the fetal body. Some incidences of this disease may be fixed by