Fetoscopic Observation of Intrauterine Operative Port Placements during Laparotomy-Assisted Fetal Myelomeningocele Closure.

IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY
Selena A Shirkin, Mariah N Snelson, Eric D McAlexander, Ayeeshi Poosarla, Gloria Kalnitskaya, Alice S Yu, Elizabeth Logsdon, Denise Wolfson, Jena L Miller, Mara Rosner, Michelle L Kush, Ahmet A Baschat
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引用次数: 0

Abstract

Introduction: Amniotic membrane disruption during laparotomy-assisted fetoscopic myelomeningocele closure port insertion is a precursor to iatrogenic preterm prelabor rupture of membranes (iPPROM), the primary contributor to obstetric complications. We hypothesized that visualization of port insertion from the intrauterine perspective could offer insight into mechanisms affecting chorioamniotic integrity.

Methods: Fetoscopically video-recorded uterine port insertions during myelomeningocele closure were independently reviewed by six observers for suture placement, associated chorioamniotic separation of the membrane (referred to as tenting), and bleeding at port insertion. Findings were analyzed for interobserver agreement and related to iPPROM and gestational age at delivery.

Results: In 23 surgical videos, average interobserver agreement was 78% for membrane tenting, myometrial bleeding, visible debris on the port, and the number of suture placements as distinct mechanical factors. Tenting occurred at 30.4% of suture and 30.4% of trocar insertions. Port step occurred in 100.0% of insertions, and port debris occurred in 60.9% of insertions. Bleeding occurred in 8.7% of port, and 21.7% of suture insertions. Amniotic membrane plication used 2 stitches in 65.2% of cases. iPPROM occurred in 47.8% of cases. The average gestational age at the time of surgery was 24 weeks and 4 days and, at the time of delivery, was 35 weeks and 3 days.

Conclusions: Fetoscopic port insertions produce identifiable chorioamniotic disruption without any specific precursors to membrane rupture. The number, rather than the type of membrane punctures, may be more relevant for iPPROM risk.

腹腔镜辅助胎儿髓膜膨出闭合术中宫内手术端口放置的宫腔镜观察。
导言:剖腹辅助胎镜下髓膜膨出闭合口插入时羊膜破裂是医源性早产胎膜破裂(iPPROM)的前兆,是产科并发症的主要原因。我们假设,从宫内角度观察子宫口插入可以深入了解影响绒毛膜-羊膜完整性的机制。方法:6名观察人员独立回顾了在髓膜脑膜膨出闭合过程中胎儿镜录像记录的子宫孔插入情况,包括缝线放置、相关的绒毛膜-羊膜分离(称为支帐)以及子宫孔插入处出血。研究结果分析了观察者之间的一致性,并与分娩时iPPROM和胎龄有关。结果:在23个手术视频中,平均观察者之间对膜tent、肌层出血、port可见碎片和缝线放置次数作为不同力学因素的一致性为78%。30.4%的缝合和30.4%的套管插入出现了帐篷状。100.0%的插入出现Port step, 60.9%的插入出现Port debris。出血发生率为8.7%,缝线插入率为21.7%。羊膜应用2针占65.2%。iPPROM发生率为47.8%。手术时平均胎龄24周4天,分娩时平均胎龄35周3天。结论:胎儿镜下的端口插入产生可识别的绒毛膜羊膜破裂,没有任何特异性的膜破裂前兆。膜穿刺的次数,而不是类型,可能与iPPROM风险更相关。
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来源期刊
Fetal Diagnosis and Therapy
Fetal Diagnosis and Therapy 医学-妇产科学
CiteScore
4.70
自引率
9.10%
发文量
48
审稿时长
6-12 weeks
期刊介绍: The first journal to focus on the fetus as a patient, ''Fetal Diagnosis and Therapy'' provides a wide range of biomedical specialists with a single source of reports encompassing the common discipline of fetal medicine.
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