Fetoscopy

What is a fetoscopy?

Fetoscopy is a procedure during pregnancy that lets your pregnancy care provider see your unborn baby inside the womb (uterus). Providers use it to evaluate and treat congenital disorders (diseases you’re born with). It involves inserting a thin, fiber-optic tube (endoscope or fetoscope) into your uterus through a tiny incision in your abdomen. It has a small camera on the end so your provider can see inside your uterus and amniotic sac (the sac that holds your baby in your uterus). The fetoscope is hollow, so your provider can insert surgical tools through it, allowing them to treat certain fetal conditions or obtain samples of tissue (biopsy). In some cases, the fetoscope is inserted through your cervix instead of through your abdomen.

When is a fetoscopy done?

Fetoscopy is performed in the second or third trimester of pregnancy to treat fetal conditions or collect biopsies.

Some of the most common conditions treated with fetoscopy are:

Twin-to-twin transfusion syndrome

Twin-to-twin transfusion syndrome is a rare, potentially life-threatening condition that occurs when identical twins aren't getting an equal share of blood while in the womb. Your surgeon uses a fetoscope to better visualize your placenta and the blood vessels causing the condition. Then, they place a laser through the fetoscope that they use to close off the blood vessels causing uneven blood flow. This procedure is called fetoscopic laser photocoagulation.

Amniotic band syndrome

Amniotic band syndrome occurs when your baby gets tangled up in bands of tissue from the amniotic sac. It can restrict blood flow or cause amputation of limbs or organs. A fetoscope allows your surgeon to insert a laser device that cuts and releases the bands of tissue around your baby.

Congenital diaphragmatic hernia (CDH)

CDH occurs when your baby has a hole in its diaphragm, which causes its abdominal organs to shift upwards, putting pressure on the lungs. This prevents their lungs from growing properly. Surgeons use fetoscopy to insert a balloon in your baby’s airway to promote lung growth. The balloon is removed several weeks later. This procedure is called fetoscopic endoluminal tracheal occlusion (FETO).

There are other conditions fetoscopy may be used for, such as treatment of placental tumors, spina bifida and other congenital diseases.

What’s the purpose of a fetoscopy?

The purpose of fetoscopy is to allow pregnancy care providers to assess and treat congenital conditions during pregnancy. In most cases, these are conditions that are life-threatening to your unborn baby. It’s performed when your baby’s provider needs to treat a disease or condition while they’re still in the womb.

What do I do to prepare for fetoscopy?

It depends on the extent of the procedure and if your healthcare provider plans to insert the fetoscope through your vagina or your abdomen. Other factors include how your provider will give you anesthesia (local or general) or if they give you other medications to decrease fetal movement during surgery. Your healthcare provider will discuss how you prepare for the procedure based on your situation.

How is fetoscopy performed?

Fetoscopy is typically performed in an operating room. Your provider may give you local anesthesia or sedative medication to reduce pain and prevent you and your unborn baby from moving during surgery.

Your surgeon follows these steps to perform the procedure:

• Your surgeon makes a small incision in your abdomen.
• Your surgeon inserts a fetoscope through the incision and into your uterus and amniotic sac.
• The fetoscope projects an image onto a screen so your surgeon can view your baby and placenta.
• Depending on the type of surgery, your surgeon will insert surgical tools through the fetoscope to perform the procedure or collect tissue samples.

If your surgeon performs the procedure through your cervix, they will first insert a speculum into your vagina. This duckbill-shaped device allows them to better see your cervix (the opening to your uterus) because it opens your vaginal wall. Then, they insert a fetoscope through your cervix and into your uterus.

Is a fetoscopy invasive?

Fetoscopy is minimally invasive. The alternative methods for fetal surgery involve making larger incisions in your abdomen near your uterus. These open abdominal procedures are more invasive and have higher risks of complications.

What are the risks of fetoscopy?

As with most surgeries, there are some risks to a fetoscopy, including:

• Preterm birth.
• Premature labor.
• Preterm premature rupture of membranes (your water breaks early).
• Loss of the pregnancy.
• Infection.
• Bleeding

What does fetoscopy tell you?

Surgeons use fetoscopy as a diagnostic and surgical tool, so it depends on why you’re having the procedure. Fetoscopy gives your baby’s healthcare provider important information on their condition. It also helps them treat conditions that may cause complications during the remainder of your pregnancy or delivery.

Some factors your provider considers after fetoscopy include:

• Type of delivery required: Your provider may decide a C-section is safest depending on your baby’s condition.
• Place of delivery: Depending on the condition, your provider will decide if special equipment or care is required during delivery.
• Timing of delivery: Your provider will decide if your pregnancy can continue or if early delivery is needed.

When do you know the results of fetoscopy?

It depends on the reason. The procedure itself isn’t a test. Rather, it’s a method providers use to evaluate and treat conditions in unborn babies. For example, if it’s performed to collect tissue, it will take a few days to get the test results. However, if your baby’s surgeon is using a laser to cut and seal irregular blood vessels, you’ll know after surgery if it was successful.

What is the recovery time after fetoscopy?

The surgery is minimally invasive, but it does take time to recover if an incision is made in your abdomen. Most people can return to normal activities the same day, being cautious around your abdominal or vaginal area. It’s best to discuss recovery instructions with your health care team based on your unique situation.

A note from Cleveland Clinic

Fetoscopy lets your healthcare team diagnose, evaluate and treat congenital disorders while your baby is still in your womb. It’s typically performed after 18 weeks of pregnancy, when most birth disorders are found. It can be potentially life-saving when used to treat or correct certain diseases. Discuss your concerns about the procedure with your pregnancy care provider. It’s normal to be scared, but let your providers reassure you that fetoscopy is safe and that they’re doing everything they can to keep your baby healthy.