Below are recent publications of interest to the Fetal Therapy community - click on the title to see the abstract.
The purpose of this study was
to evaluate the benefit of cervical cerclage for cervical length ≤ 25 mm
at the time of fetoscopic laser photocoagulation (FLP) for twin-twin
retrospective cohort study was conducted with 163 patients with a short
cervix before FLP for twin-twin transfusion syndrome. Seventy-nine of
the patients (48%) had cerclage placement at the surgeon's discretion.
The outcome measures that were compared were gestational age at delivery
and perinatal mortality rates for patients with cerclage and those who
were treated conservatively. Outcomes were evaluated with the use of
There were no
differences in the preoperative variables, except cerclage was performed
more frequently for a cervical length of ≤ 15 mm (P < .001). There
were no differences in the gestational age at delivery (28.8 ± 5.4 vs
29.1 ± 5.6 weeks with and without cerclage, respectively; P = .15);
perinatal mortality rates were similar between the 2 groups.
The benefit of cerclage for patients with short cervix before FLP remains questionable.
Copyright © 2012 Mosby, Inc. All rights reserved.
Fetal cardiac intervention: Improved results of fetal cardiac bypass in immature fetuses using the TinyPump device.
J Thorac Cardiovasc Surg. 2012 Aug 31. [Epub ahead of print]
Fetal cardiac surgery is a potential innovative treatment for certain congenital heart defects that have significant mortality and morbidity in utero or after birth, but it has been limited by placental dysfunction after fetal cardiac bypass. We have used the TinyPump device for fetal cardiac bypass in sheep fetuses at 90 to 110 days gestation.
Ten mixed-breed pregnant ewes were used over a period of 6 months, and 10 fetuses were placed on bypass for 30 minutes. Five fetuses with a mean gestational age of 104 ± 4.5 days and mean weight of 1.4 ± 0.4 kg were placed on bypass using the TinyPump device, and 5 fetuses with a mean gestational age of 119 ± 4.5 days and mean weight of 3.4 ± 0.4 kg were placed on bypass using the roller head pump. The fetuses were monitored for up to 3 hours after bypass or until earlier demise.
Progressive respiratory and metabolic acidosis developed in all fetuses. The TinyPump group had a lower gestational age and weight compared with the roller head pump group. However, the rate of postbypass deterioration in the TinyPump group, as measured with blood gases, was noted to be significantly slower compared with the roller head pump group.
We demonstrate the feasibility of the TinyPump device for fetal cardiac bypass in a fetal sheep model. The TinyPump group showed improved results compared with the roller head group despite more immature fetuses. The TinyPump device seems to be a promising device for future studies of fetal cardiac bypass in immature fetal sheep and in primates.
Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Histologic changes of the fetal membranes after fetoscopic laser surgery for twin-twin transfusion syndrome.Pediatr Res. 2015.
Preterm premature rupture of membranes remains a major complication after fetoscopic laser surgery (FLS) for twin-twin transfusion syndrome (TTTS). We studied the histologic changes of fetal membranes post-FLS and investigated a possible impact of amniotic fluid (AF) dilution.
Fetal membranes of 31 pregnancies that underwent FLS for TTTS were investigated histologically at delivery at different sites: trocar site of recipient sac and at distance, donor sac, and inter-twin membrane.
The trocar insertion site on the recipient sac showed no signs of histologic hallmarks of healing. Wide-spread alteration in collagen organization and higher apoptotic index in the amnion of the recipient sac which were absent in donor's and reference membranes. To explain the mechanisms, we analyzed the AF composition of recipient sacs from TTTS pregnancies vs. GA-matched healthy singleton controls and found glucose, protein and lactate dehydrogenase activity were all significantly lower in TTTS sacs consistent with over-dilution of recipient's AF (~2-fold). In-vitro exposure of healthy amniochorion to analogous dilutional stress conditions recapitulated the histologic changes and induced apoptosis and autophagy.
Alteration in structural integrity of the recipient's amniochorion, possibly in response to dilution stress, along with ineffective repair mechanisms may explain the increased incidence of preterm birth post-FLS.