fetoscopic

Fetoscopic refers to procedures that use a fetoscope, a slender endoscope designed for intrauterine visualization of the fetus and placental structures. Fetoscopy is a minimally invasive prenatal technique used for both diagnosis and therapy when feasible, typically performed through a small abdominal incision and a puncture into the uterus.

A fetoscope provides real-time video and may be equipped with illumination and specialized micro-instruments. Procedures are usually guided by ultrasound and sometimes additional imaging. The uterus or amniotic cavity is distended with a sterile fluid to create a working space for visualization and instrument manipulation. Fetoscopic interventions are performed by specialized multidisciplinary teams in centers equipped for fetal surgery.

Indications and applications include diagnostic visualization of fetal anatomy and targeted fetal therapies. The most established use is in twin-twin transfusion syndrome, where fetoscopic laser photocoagulation of placental vascular anastomoses can equalize blood flow between twins. Other applications in select cases include fetoscopic procedures such as tracheal occlusion for severe congenital diaphragmatic hernia and various intrauterine procedures aimed at treating fetal conditions or reducing complications. In some settings, fetoscopy is used to access fetal organs for treatment or to place temporary shunts or perform laser-based or mechanical interventions.

Risks associated with fetoscopic procedures include preterm labor, membrane rupture, infection, bleeding, and fetal or placental injury, as well as maternal anesthesia-related risks. Outcomes vary by indication and center, with some procedures improving fetal survival or conditions in carefully selected pregnancies, while others carry notable maternal-fetal mortality and morbidity. The field continues to evolve with ongoing research and refinement of techniques.