Fetaloscopy

The fetal mirror is a amniocentesis or a laparoscopic mirror, which is a very thin optical fiber endoscope. Fetal microscopy is a fetal prenatal diagnosis method that allows the fetal mirror to enter the amniotic cavity through the abdominal wall and uterine wall, directly observe the fetal surface, and perform simple operations. It is still in the research stage. In 1954, Westin et al. used a hysteroscope with a diameter of 10 mm to enter the amniotic cavity of pregnancy 14-18 weeks through the cervical canal to observe the condition of the fetus, placenta and umbilical cord, and set a precedent for amniocentesis. The true fetal microscopy was performed in 1970 by Valenti and Scrim•geour using an optical fiber bundle endoscope with a diameter of 2.7 mm. The uterus was examined before a cesarean section in a full-term pregnancy to observe the condition of the fetus and to be successful. In 1974, Hobbins and Maboney reported that fetal tissue biopsy was performed under local anesthesia and fetal blood samples were taken by umbilical vein puncture. Basic Information Specialist Category: Maternity Check Category: Endoscope Applicable gender: whether women are fasting: not fasting Tips: Pregnant women empty the bladder, routine abdominal preparation. Normal value The fetus grows healthy, the body is well-proportioned, and the organ tissue is developing normally. Clinical significance Abnormal result 1. Diagnosis of congenital fetal malformations with obvious shape changes by direct observation. For example, cleft lip, cleft palate, multi-finger malformation, limb deformity syndrome, osteochondral dysplasia, open neural tube malformation, visceral valgus, umbilical bulging, abdominal wall fissure and visceral retraction, conjoined twins, multiple limbs, large pieces Hemangioma, external genital malformations, and so on. These diseases can be directly diagnosed by fetal mirror. 2. Congenital diseases diagnosed by fetal biopsy. (1) Fetal skin biopsy, mainly used to diagnose serious genetic skin diseases, such as bullous skin lysis, fish scale erythroderma, plaque plaque or flaky squama. (2) Fetal liver tissue biopsy is performed on patients with fetal liver disease or diseases related to fetal liver enzyme metabolism. (3) fetal muscle tissue biopsy, such as fetal pseudohypertrophic muscular dystrophy, progressive spinal atrophy and so on. 3. Take the blood of the fetus for diagnosis. It can diagnose hemoglobin diseases such as thalassemia, sickle-type anemia, hemophilia, chronic granulomatosis, galactosemia, mucopolysaccharidosis, maternal and child blood group incompatibility, genetic immunodeficiency disease, intrauterine viral infection. 4. Perform intrauterine treatment. Intrauterine blood transfusion can be performed on severe fetal hemolytic anemia by fetal mirror; for multiple pregnancy, one of the fetal malformations can be sacrificed by malformed fetal heart puncture and air embolization; or one child with twin transfusion syndrome is sacrificed. One child; the drainage tube is placed on the hydrocephalus to reduce the intracranial pressure, and the brain tissue is controlled to cause further damage and atrophy; for the urinary tract obstruction, the drainage tube can also be placed to reduce the pressure and atrophy of the kidney. 5. Gene and cell therapy. In recent years, the development of gene therapy and cell therapy has been very rapid. In the early stage of embryonic development, the fetal immune system has not yet been fully established, and the fetal mirror can transport genes or cells into the body of the fetus for therapeutic purposes. At present, the methods related to gene therapy are still under study, and the cells that can be input into the fetus are only bone marrow cells, and research in this field is still underway. People who need to be examined for fetal dysplasia and fetal developmental examinations. Precautions Check attention: 1. B-examination, size, determination of the fetal position, placenta and fetus. Understand the position of the placenta, the amount of amniotic fluid, estimate the puncture point of the fetus to choose the fetal mirror, try to avoid the fetus. 2. Pregnant women empty the bladder and routinely prepare the skin for the abdomen. 3. The sedative should be given 10 minutes before surgery, and 10mg intramuscular injection can be given to achieve the purpose of sedation and reduce fetal activity. Can also be used to cold 100 mg intramuscular injection. Requirements for inspection: Actively cooperate with the doctor's work. Inspection process 1. Pregnant women take a supine position and routinely disinfect the towel. 2. At the selected puncture site, after local infiltration anesthesia, the skin is cut 2-5 mm deep into the skin, and the incision should be perpendicular to the uterine surface. 3. After the assistant fixes the uterus, the ampulla is used to pierce the amniotic cavity vertically through the abdominal wall incision, and there is a secondary sensation when passing through the abdominal wall and the uterine wall. It is estimated that when entering the amniotic cavity, the needle core is withdrawn, and the trocar has amniotic fluid outflow, indicating that it has entered the amniotic cavity. If you want amniocentesis, you can do this at this time, then insert the fetal mirror. 4. After turning on the cold light source, observe the shape of the fetus under the guidance of B-ultrasound, such as fingers, face, genitals, etc. In the direct observation, affected by the transparency of amniotic fluid, the observation effect may be affected when the cellular components in the amniotic fluid increase or the fetus is contaminated or bleeding. 5. If fetal blood sampling is required, insert the sampling needle to take blood when the umbilical cord is seen during the observation process, or take blood from the larger blood vessel on the surface of the placenta. 6. If a fetal tissue biopsy is required, first remove the fetal mirror, insert the biopsy forceps, and take the specimen under the guidance of B-ultrasound. 7. After the operation is completed, the fetal mirror and the cannula are simultaneously pulled out, and the puncture site is pressed with gauze for 5 minutes to cover the dressing. Use B-ultrasound to observe whether there is active bleeding at the puncture site, whether the fetal heart rate and fetal activity are normal. At the same time, observe the blood pressure, heart rate, fetal heart rate, presence or absence of uterine contraction, and leakage of amniotic fluid. hour. Not suitable for the crowd Inappropriate crowd: 1. Pregnant women with bleeding tendency, such as severe pregnancy-induced hypertension, pregnancy with thrombocytopenia. 2. There are abortions or premature births during pregnancy. 3. Suspicious intrauterine infections, such as elevated white blood cells and so on. 4. Those with severe pregnancy complications. Adverse reactions and risks Nothing.