fetoscopy

Fetoscopy is a minimally invasive medical technique that uses a small endoscopic instrument, the fetoscope, to visualize the fetus and surrounding structures through the pregnant uterus. It can be used for diagnostic purposes, providing direct visualization of fetal anatomy, and for therapeutic purposes, enabling intrauterine interventions. Most procedures are performed via a small transabdominal incision under ultrasound guidance, with a saline-filled uterus to create a working space. Specialized instruments can be passed alongside the fetoscope to perform tasks such as tissue sampling, laser coagulation, or the placement of shunts.

Indications include assessment of suspected fetal anomalies detected on ultrasound, targeted biopsies or sampling, and therapeutic intrauterine procedures. The most established therapeutic use is for twin‑twin transfusion syndrome, where fetoscopic laser photocoagulation of placental vascular connections improves outcomes. Other intrauterine procedures include fetoscopic laser-assisted placental surgery, fetoscopic valve or shunt placement, and, in selected cases, fetal repairs of conditions such as spina bifida or diaphragmatic hernia, though these are performed in specialized centers.

Risks associated with fetoscopy include rupture of membranes, preterm labor, infection, bleeding, fetal injury, and anesthesia-related risks for the mother. Outcomes depend on indication, gestational age, and operator experience. Fetoscopy is typically offered in tertiary fetal medicine centers with multidisciplinary teams and appropriate ethical oversight. Ongoing research aims to expand indications, improve safety, and refine techniques.