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Introduction ⬇

Fetoscopy is an invasive endoscopic procedure that allows direct observation of the fetus and facilitates fetal blood sampling, skin or muscle biopsy, or fetal therapy. It provides direct visualization of the fetus in 2- to 4-cm segments so that developmental defects can be more accurately identified. The fetal blood sample allows early diagnosis of disorders such as hemophilia A and B that are not amenable to detection through other means. Fetoscopy can also be used for therapeutic interventions in conditions such as abnormal vascular connection in twin–twin transfusion, congenital diaphragmatic hernia, fetal bladder outlet obstruction, and amniotic band syndrome. Because there are risks associated with fetoscopy, it is only offered when there is a significant risk of a major birth defect that can be diagnosed or treated by this method.

Procedure ⬆ ⬇

  1. Obtain a properly signed and witnessed consent form.

  2. Apply a local anesthetic to the patient’s abdominal wall. Sedation may be given to the patient to quiet the fetus.

  3. Use real-time ultrasound to locate the proper maternal abdominal area through which to make a small incision and then insert the cannula and the trocar into the uterus.

  4. After cannulation into the uterus, insert an endoscope (fetoscope), consisting of a fiberoptic light source and a self-focusing lens, and then manipulate for optimal views and fetal tissue sampling (e.g., skin, blood, amniotic fluid).

Procedural Alert

Fetoscopy poses an increased risk for spontaneous miscarriage (5%–10%), preterm delivery (10%), amniotic fluid leakage (1%), and intrauterine fetal death

Clinical Implications ⬆ ⬇

Abnormal results may reveal:

  1. Fetal malformation

  2. Neural tube defects

  3. Sickle cell anemia

  4. Hemophilia

Interventions ⬆ ⬇

Pretest Patient Care

  1. Genetic counseling and a thorough explanation of the procedure and its benefits, risks, and limitations should be provided.

  2. Ensure that the patient has not taken anything orally for the prescribed amount of time, as ordered. Administer antibiotics as ordered before the procedure to prevent amnionitis. Assess for possible allergies to the drug.

  3. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Monitor the patient and fetus for several hours after the procedure. Institute proper protocols for dealing with maternal blood pressure and pulse changes, FHR abnormalities, uterine activity, vaginal bleeding, or amniotic fluid leakage. Rh-negative patients should receive human Rho(D) immune globulin (RhoGAM) unless the fetus is also known to be Rh negative.

  2. Repeat ultrasound studies should be done to check amniotic fluid volume (AFV) and fetal viability.

  3. Instruct the patient to report any pain, bleeding, infected cannulation site, amniotic fluid leakage, or fever (amnionitis).

  4. Review test results; report and record findings. Modify the nursing care plan as needed.

  5. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Reference Values ⬆

Normal