Fetal Surgery | ScienceGate

Abstract Background: Use of high-dose inhalational anesthesia during open fetal surgery may induce maternal–fetal hemodynamic instability and fetal myocardial depression. The authors’ preliminary human retrospective study demonstrated less fetal bradycardia and left ventricular systolic dysfunction with lower dose desflurane supplemented with propofol and remifentanil IV anesthesia (SIVA). In this animal study, the authors compare maternal–fetal effects of high-dose desflurane anesthesia (HD-DES) and SIVA. Methods: Of 26 instrumented midgestational ewes, data from 11 animals exposed to both SIVA and HD-DES in random sequences and six animals exposed to HD-DES while maternal normotension was maintained were analyzed. Maternal electroencephalography was used to guide comparable depths of anesthesia in both techniques. Hemodynamic parameters, blood gas, and fetal cardiac function from echocardiography were recorded. Results: Compared with SIVA, HD-DES resulted in significant maternal hypotension (mean arterial pressure difference, 19.53 mmHg; 95% CI, 17.6–21.4; P < 0.0001), fetal acidosis (pH 7.11 vs. 7.24 at 150 min, P < 0.001), and decreased uterine blood flow. In the HD-DES group with maternal normotension, uterine blood flow still declined and fetal acidosis persisted, with no statistically significant difference from the group exposed to HD-DES that had maternal hypotension. There was no statistically significant difference in fetal cardiac function. Conclusion: In sheep, SIVA affects maternal hemodynamics less and provides better fetal acid/base status than high-dose desflurane. Fetal echocardiography did not reflect myocardial dysfunction in this model.

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Fetal surgery for myelomeningocele

Child s Nervous System ◽

10.1007/s00381-003-0787-0 ◽

2003 ◽

Vol 19 (7-8) ◽

pp. 587-591 ◽

Cited By ~ 16

Author(s):

Leslie N. Sutton ◽

N. Scott Adzick ◽

Mark P. Johnson

Keyword(s):

Fetal Surgery

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Evaluation of the Fetal Therapy Evidence in Lower Urinary Tract Obstruction: Would an ERAS Guideline Improve Outcomes?

Fetal Diagnosis and Therapy ◽

10.1159/000517624 ◽

2021 ◽

pp. 1-13

Author(s):

R. Douglas Wilson ◽

Gregg Nelson

Keyword(s):

Quality Improvement ◽

Urinary Tract ◽

Lower Urinary Tract ◽

Urinary Tract Obstruction ◽

Fetal Surgery ◽

Fetal Therapy ◽

Lower Urinary Tract Obstruction ◽

Evidenced Based ◽

Process Elements ◽

Lower Urinary

Background: Pregnancies that are prenatally identified to have fetal anomalies are complex and require expert multidisciplinary care. As many conditions can impact the fetus prenatally and require intervention, an enhanced recovery after surgery (ERAS) for lower urinary tract obstruction (LUTO) is being evaluated to determine the level of evidenced-based data available. Problem: The percutaneous ultrasound-guided fetal surgery procedure for bladder neck obstruction is the focus for elements of preoperative counseling, intraoperative procedure/risk complications, and postoperative management. Methods: A quality improvement review Squire 2.0 (2000–2020) was undertaken for the percutaneous LUTO fetal surgery shunting (lower urinary tract obstruction), process and procedure which require 2 process pathways, one to evaluate the fetal candidate and a second to treat. This structured review is focused on identifying the process elements to allow the determination of the number of evidenced-based elements that would allow for audit and measurement of the clinical element variance for comparative feedback to the individual surgical provider or surgery center. Interventions: Titles and abstracts were screened to identify potentially relevant articles with priority given to meta-analyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series. Results: A series of potential clinical elements for the diagnostic fetal evaluation and for the 3 protocol areas of surgical care for the procedures (pre-, intra-, and postoperative care) are identified using an ERAS-like process. Conclusions: The identified clinical elements have the potential for ERAS-LUTO fetal therapy guideline. Multidisciplinary collaboration (surgeon, anesthesia, nursing, imaging, and laboratory) is required for ERAS quality improvement in the pre-, intra-, and postoperative processes. Process elements in each of the operative areas can be audited, evaluated, compared, and modified/improved.

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Contrast‐enhanced ultrasound imaging can be used to evaluate fetal cerebral perfusion: potential implications for fetal surgery

Translational Medicine Communications ◽

10.1186/s41231-021-00087-0 ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Kendall M. Lawrence ◽

Barbara E. Coons ◽

Anush Sridharan ◽

Avery C. Rossidis ◽

Marcus G. Davey ◽

...

Keyword(s):

Carbon Dioxide ◽

Cerebral Perfusion ◽

Fetal Surgery ◽

Time Dependent ◽

Contrast Enhanced Ultrasound ◽

Acid Base ◽

Fetal Sheep ◽

Contrast Enhanced ◽

Support Device ◽

Acid Base Status

Abstract Background Fetal surgery is increasingly performed to correct congenital defects. Currently, fetal brain perfusion cannot be assessed intra-operatively. The purpose of this study was to determine if contrast-enhanced ultrasound (CEUS) could be used to monitor fetal cerebral perfusion during fetal surgery and if parameters correlate with fetal hemodynamics or acid/base status. Methods Cannulated fetal sheep were insufflated with carbon dioxide gas in an extra-uterine support device and in utero to mimic fetal surgery. Fetal heart rate, mean arterial pressure, and arterial blood gases were serially measured. CEUS examinations of the brain were performed and time-dependent metrics were quantified to evaluate perfusion. The relationships between measured parameters were determined with mixed linear effects models or two-way repeated measures analysis of variance. Results 6 fetal sheep (113 ± 5 days) insufflated at multiple time-points (n = 20 experiments) in an extra-uterine support device demonstrated significant correlations between time-dependent perfusion parameters and fetal pH and carbon dioxide levels. In utero, 4 insufflated fetuses (105 ± 1 days) developed hypercarbic acidosis and had reductions in cerebral perfusion parameters compared to age-matched controls (n = 3). There was no significant relationship between cerebral perfusion parameters and fetal hemodynamics. Conclusions CEUS-derived cerebral perfusion parameters can be measured during simulated fetal surgery and strongly correlate with fetal acid/base status.

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‘We did everything we could’– A qualitative study exploring the acceptability of maternal‐fetal surgery for spina bifida to parents

Prenatal Diagnosis ◽

10.1002/pd.5996 ◽

2021 ◽

Author(s):

Neeltje Crombag ◽

Adalina Sacco ◽

Bernadette Stocks ◽

Philippe De Vloo ◽

Johannes Van Der Merwe ◽

...

Keyword(s):

Spina Bifida ◽

Qualitative Study ◽

Fetal Surgery

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Right-sided congenital diaphragmatic hernia in a decade of fetal surgery

BJOG An International Journal of Obstetrics & Gynaecology ◽

10.1111/1471-0528.13065 ◽

2014 ◽

Vol 122 (7) ◽

pp. 940-946 ◽

Cited By ~ 32

Author(s):

P DeKoninck ◽

O Gomez ◽

I Sandaite ◽

J Richter ◽

K Nawapun ◽

...

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Fetal Surgery

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Implantable Ultralow Pulmonary Pressure Monitoring System for Fetal Surgery

IEEE Transactions on Information Technology in Biomedicine ◽

10.1109/titb.2012.2207399 ◽

2012 ◽

Vol 16 (6) ◽

pp. 1208-1215 ◽

Cited By ~ 2

Author(s):

M. Etemadi ◽

J. A. Heller ◽

S. C. Schecter ◽

E. H. Shue ◽

D. Miniati ◽

...

Keyword(s):

Monitoring System ◽

Fetal Surgery ◽

Pressure Monitoring ◽

Pulmonary Pressure

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Anaesthesia for fetal surgery

Best Practice & Research Clinical Anaesthesiology ◽

10.1053/bean.2000.0125 ◽

2000 ◽

Vol 14 (4) ◽

pp. 759-769

Author(s):

D Strümper ◽

W Gogarten ◽

A.E Marcus

Keyword(s):

Fetal Surgery

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TGF-beta-3 Promotes Scarless Repair of Cleft Lip in Mouse Fetuses

Journal of Dental Research ◽

10.1177/154405910208101007 ◽

2002 ◽

Vol 81 (10) ◽

pp. 688-694 ◽

Cited By ~ 24

Author(s):

K. Kohama ◽

K. Nonaka ◽

R. Hosokawa ◽

L. Shum ◽

M. Ohishi

Keyword(s):

Cell Proliferation ◽

Cyclin D1 ◽

Cleft Lip ◽

Ex Vivo ◽

Fetal Surgery ◽

Mesenchymal Cell ◽

Tenascin C ◽

Cleft Lip Repair ◽

Mouse Fetuses ◽

Mesenchymal Transformation

TGF-β3 mediates epithelial-mesenchymal transformation during normal fusion of lip and palate, but how TGF-β3 functions during cleft lip repair remains unexplored. We hypothesize that TGF-β3 promotes fetal cleft lip repair and fusion by increasing the availability of mesenchymal cells. In this investigation, we demonstrated that cleft lips in mouse fetuses were repaired by fetal surgery, producing scarless fusion. At the site of the operation, we first observed an infusion of platelets expressing TGF-β3, followed by increased expression of cyclin D1 and tenascin-C, and coupled with increased mesenchymal cell proliferation. In an ex vivo serumless culture system, cleft lip explants fused in the presence of exogenous TGF-β3. Cultured lips also showed up-regulation in cyclin D1 and tenascin-C expression. These findings suggest that microsurgical repair of cleft lip in the fetus that produced scarless fusion is mediated by TGF-β3 regulation of mesenchymal cell proliferation and migration at the site of repair.

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