fetoscope

A fetoscope is a slender endoscope used to visualize the fetus inside the uterus during pregnancy. It enables direct viewing of fetal anatomy and can provide access for diagnostic sampling or therapeutic intervention in selected cases. The instrument is designed to be inserted through the maternal abdomen (transabdominal) or, less commonly, through the cervix (transcervical), under ultrasound guidance. Modern fetoscopes include a light source, camera, and a working channel that may accommodate small instruments such as laser fibers, forceps, or scissors. Most procedures rely on the amniotic cavity’s natural space and do not require routine inert gas insufflation.

Procedures and indications vary by case. The most established use is in the treatment of twin-to-twin transfusion syndrome in monochorionic twin pregnancies, where fetoscopic laser photocoagulation of placental vascular connections helps balance blood flow between twins. Fetoscopy is also used in certain forms of fetal surgery, including attempts to repair open neural tube defects such as spina bifida in selected cases, often via minimally invasive, endoscopic techniques. Other applications include targeted fetal biopsy or treatment tasks that require direct visualization and instrumentation.

Risks and considerations are significant and include maternal complications such as infection, bleeding, or rupture of membranes, as well as fetal risks like preterm labor or fetal loss. Because outcomes depend on the indication and the surgeon’s experience, fetoscopy is typically performed in specialized centers with multidisciplinary fetal medicine teams. Overall, advances in fetoscopy have expanded the range of minimally invasive options in prenatal diagnosis and fetal therapy.

History and development: The concept emerged in the mid-20th century with progressive refinements in fetal visualization and surgical techniques, achieving broader clinical use during the late 20th and early 21st centuries.