Fetal diagnosis and therapy · 2025
Effects of in utero Open Spina Bifida Repair Using a Laparotomy-Assisted Fetoscopic Approach on the Fetal Cardiovascular System.
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Albrecht Annika, Reitz Justus G, Bedei Ivonne, Windhorst Anita C, Keil Corinna, Köhler Siegmund, Wolter Aline, Schmitt Nicolas, Kalmus Gerald, Sass Benjamin, Schulze Maximilian, Axt-Fliedner Roland
Аннотация
INTRODUCTION: Various treatment options for the prenatal open spina bifida (OSB) repair have evolved over the past decades, including the laparotomy-assisted fetoscopic repair. However, little is known about the fetal vascular regulation during the laparotomy-assisted fetoscopic repair. Therefore, we aimed to describe cardiovascular effects during the intervention in our cohort.
METHODS: A total of 26 fetuses underwent laparotomy-assisted fetoscopic repair at a single center between July 2021 and July 2024 and were prospectively included in this study. The intervention was performed using a three-port, three-layer fetoscopic repair of OSB via a laparotomy-assisted approach. Fetal heart rate (FHR) and pulsed-wave Doppler flow measurement of the pulsatility index (PI) in the umbilical artery (UA) and middle cerebral artery (MCA) were recorded at 13 defined time points throughout the surgery. The occurrence of absent or reverse end-diastolic (ARED) UA flow was documented. The MCA waveform was assessed for signs of fetal vasoconstriction (M-sign).
RESULTS: The mean gestational age at surgery was 25 weeks. A significant increase in the PI in the UA before laparotomy (PI: 1.22 ± 0.24) and after laparotomy (PI: 1.75 ± 0.37) was observed (p < 0.001). An ARED flow was recorded in 13.3% of cases after maternal general anesthesia, but not before and at the latest on the first day after surgery. MCA PI decreased nonsignificantly during the intervention. Before surgery, the M-sign was present in 6 fetuses; however, during surgery, it was seen only in 1 fetus. There were no significant changes in FHR during surgery except for a drop after gas insufflation (FHR: 129 ± 5; FHR: 125 ± 7.0, p < 0.001) compared to the FHR before surgery. During the postoperative course, the FHR increased significantly (day 0: 141 ± 10; day 4: 143 ± 9.8, p = 0.003).
CONCLUSION: Our study shows changes in the UA PI and the occurrence of ARED during laparotomy-assisted fetoscopic repair. FHR remained stable during surgery. Furthermore, the findings confirm the transient nature of these changes. The occurrence of Doppler and waveform abnormalities was related to maternal-fetal anesthesia and the procedure itself.
METHODS: A total of 26 fetuses underwent laparotomy-assisted fetoscopic repair at a single center between July 2021 and July 2024 and were prospectively included in this study. The intervention was performed using a three-port, three-layer fetoscopic repair of OSB via a laparotomy-assisted approach. Fetal heart rate (FHR) and pulsed-wave Doppler flow measurement of the pulsatility index (PI) in the umbilical artery (UA) and middle cerebral artery (MCA) were recorded at 13 defined time points throughout the surgery. The occurrence of absent or reverse end-diastolic (ARED) UA flow was documented. The MCA waveform was assessed for signs of fetal vasoconstriction (M-sign).
RESULTS: The mean gestational age at surgery was 25 weeks. A significant increase in the PI in the UA before laparotomy (PI: 1.22 ± 0.24) and after laparotomy (PI: 1.75 ± 0.37) was observed (p < 0.001). An ARED flow was recorded in 13.3% of cases after maternal general anesthesia, but not before and at the latest on the first day after surgery. MCA PI decreased nonsignificantly during the intervention. Before surgery, the M-sign was present in 6 fetuses; however, during surgery, it was seen only in 1 fetus. There were no significant changes in FHR during surgery except for a drop after gas insufflation (FHR: 129 ± 5; FHR: 125 ± 7.0, p < 0.001) compared to the FHR before surgery. During the postoperative course, the FHR increased significantly (day 0: 141 ± 10; day 4: 143 ± 9.8, p = 0.003).
CONCLUSION: Our study shows changes in the UA PI and the occurrence of ARED during laparotomy-assisted fetoscopic repair. FHR remained stable during surgery. Furthermore, the findings confirm the transient nature of these changes. The occurrence of Doppler and waveform abnormalities was related to maternal-fetal anesthesia and the procedure itself.