Fetal Diagnosis and Therapy最新文献

{"title":"Maternal Subcutaneous Seroma following Open Maternal Fetal Surgery for Closure of Fetal Open Neural Tube Defects.","authors":"Desiree Fiorentino, Christina Paidas Teefey, Shelly Soni, Nahla Khalek, Alekhya Jampa, Gregory G Heuer, Alan W Flake, Holly L Hedrick, William H Peranteau, N Scott Adzick, Julie S Moldenhauer, Juliana S Gebb","doi":"10.1159/000550640","DOIUrl":"10.1159/000550640","url":null,"abstract":"<p><p><p>Introduction: Maternal seroma has been noted following open maternal fetal surgery (OMFS) for fetal neural tube defect (fNTD) closure but the risk factors, timing of diagnosis, natural course, and clinical significance have not been reported.</p><p><strong>Methods: </strong>Retrospective review of 340 patients who underwent OMFS for fNTD at a single center. Archived postoperative ultrasound images were reviewed and seroma details on serial ultrasound imaging were recorded. Perioperative characteristics and delivery outcomes were then compared in patients that did or did not develop a maternal seroma after OMFS. Multivariable logistic regression was performed to identify risk factors for seroma formation.</p><p><strong>Results: </strong>Of 330 patients with ongoing pregnancies at least 10 days after OMFS, 122 (37%) patients had sonographic evidence of seroma. Median postoperative day at diagnosis was 11 with median time to resolution of 21 days. Median longest diameter at diagnosis was 5.23 cm with a median initial volume of 9.66 mL. Seromas minimally increased in size prior to resolution. Multivariable logistic regression identified increasing maternal age and body mass index (BMI) as statistically significant risk factors for seroma formation (OR 1.08 and 1.17, respectively). There was no difference in the incidence of post-OMFS complications in those who developed seroma and those who did not, including no difference in the rate of membrane separation, oligohydramnios, preterm premature rupture of membranes, placental abruption, preterm labor, gestational age at delivery, fetal demise, or hysterotomy dehiscence. Following cesarean delivery, there was no difference in wound infection, but there was a higher incidence of wound separation in the group that had a seroma (7.4% vs. 1.9%, p = 0.019).</p><p><strong>Conclusion: </strong>In this cohort, one-third of patients undergoing OMFS developed seroma with no associated change in wound healing or prenatal course. Risk factors included older maternal age and increased BMI. The majority were small and resolved, without intervention, prior to delivery. Following cesarean delivery, there was an increased rate of wound separation in patients who previously had postoperative seroma. </p>.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"376-383"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146029069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Normalization of the Middle Cerebral Artery Resistance Index: A Sign for Adequate Untethering of the Spinal Cord and Regression of Hindbrain Herniation after Fetal Spina Bifida Repair?","authors":"Ladina Rüegg, Ladina Vonzun, Julia Wawrla-Zepf, Nele Strübing, Martin Meuli, Luca Mazzone, Ueli Möhrlen, Nicole Ochsenbein-Kölble","doi":"10.1159/000549020","DOIUrl":"10.1159/000549020","url":null,"abstract":"<p><p><p>Introduction: In fetuses with open spina bifida (fSB), reduced middle cerebral artery resistance index (MCA-RI) has been described. In theory, compression of specific neuronal pathways due to hindbrain herniation (HH) leads to an imbalance of the autonomic nervous system, favoring sympathetic pathways with increased peripheral vasoconstriction resulting in reduced MCA-RI (similar to the brain sparing effect). While untethering the neural placode, the unavoidable surgical manipulation may lead to a temporarily increased tension of the spinal cord and even aggravate HH and compression of neuronal pathways. We assume that along with untethering the spinal cord, the downward pull disappears with a consequent ascensus of the cord, and HH regression (i.e., the hindbrain moves cephalad and out of the foramen magnum) and MCA values normalize after fSB repair. To confirm this hypothesis, the aim of this study was to compare MCA-RI values obtained before, during, and after fetal surgery.</p><p><strong>Methods: </strong>In this prospective study, 28 consecutive patients operated for fSB were included. Ultrasound examinations of the MCA Doppler were performed pre-, intra-, and postoperatively with special focus on measurements during surgery, particularly while untethering the placode. Postoperatively, the HH regression was assessed. Regression of HH is defined as any degree of hindbrain decompression, which is marked by an ascensus of the hindbrain into the posterior fossa and, consequently, by the presence of cerebrospinal fluid around the cerebellum seen on US. MCA measurements were then compared with the postoperative HH regression.</p><p><strong>Results: </strong>MCA-RI before surgery was 0.82 ± 0.02. Intraoperative MCA-RI obtained during untethering was significantly lower than the presurgical values (0.75 ± 0.11, p = 0.03). After fSB repair, the MCA-RI was significantly higher than during surgery (0.83 ± 0.08, p = 0.04). Sonographic findings showed preoperative HH in 24/28 cases (86%), where 23/24 (96%) regressed after fSB repair.</p><p><strong>Conclusion: </strong>This study provides evidence that there might be cerebral blood flow redistribution, potentially due to iatrogenic forces applied to the spinal cord during the fetal operation. Postoperative HH regression seems to be associated with normalization of cerebral hemodynamics. </p>.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"272-278"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12707864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balancing How Much We Want to Know with What We Are Willing to Pay: A Comparative Cost Analysis of Prenatal Cytogenetic Testing and Screening Strategies.","authors":"Mark I Evans, Lawrence Prensky, Howard S Cuckle","doi":"10.1159/000549331","DOIUrl":"10.1159/000549331","url":null,"abstract":"<p><p><p>Introduction: Invasive prenatal diagnostic tests have higher detection rates than screening tests. Cell-free DNA (cfDNA) screening has higher detection than combined testing (CT). We estimated the cost per cytogenetic abnormality diagnosed for prenatal testing and screening methods (US data).</p><p><strong>Methods: </strong>We compared seven strategies: universal diagnosis with microarray and karyotype; cfDNA screening with four methodologies: Digital Analysis of Selected Regions (DANSR), massively parallel shotgun sequencing (MPSS), single-nucleotide polymorphisms (SNPs), and rolling circle amplification (RCA); and CT. Five abnormality groupings were considered: common autosomal trisomies (21,18,13), sex chromosome aneusomies, triploidy, clinically significant sub-chromosome changes, and copy number variants. Prevalence, detection, false-positive rates, and unit costs (literature) were obtained. The detection rate was aggregated across groups as were costs, including diagnostic tests following positive screening results.</p><p><strong>Results: </strong>All six high detection strategies had greater cost per abnormality diagnosed than CT (USD 26,100). The costliest was cfDNA using MPSS (USD 96,100), followed by universal karyotyping (USD 95,900), cfDNA using SNPs, DANSR (USD 94,800-USD 92,800), universal microarray (USD 56,600), and cfDNA with RCA (USD 32,200). The additional cost per extra abnormality diagnosed compared to CT (\"marginal\" cost) was the lowest for cfDNA with RCA (USD 45,000); others were considerably higher (USD 59,400-USD 160,700).</p><p><strong>Conclusion: </strong>Preferred prenatal strategies vary among stakeholders. However, as monopolies (large systems and Accountable Care Organizations) now control the majority of American healthcare policy decisions, the lowest cost cfDNA screening will likely prevail in actual practice. </p>.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"319-327"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12716843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145421497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-Set Ears: A New Marker of Fetal Chromosomal Anomalies.","authors":"Elisabet Baldrich-Martin, Gloria Jalencas, Isabel Mazano, Cristina Lesmes-Heredia, Josep-Maria Manresa-Dominguez, Maria Iniguez-Cruz, Joan-Carles Ferreres, Viviana Beltran, Antoni Borrell","doi":"10.1159/000548946","DOIUrl":"10.1159/000548946","url":null,"abstract":"<p><p><p>Introduction: The aim of this study was to assess the clinical utility of low-set ears (LSE) as a novel 2D-ultrasound marker for the prenatal detection of chromosomal anomalies.</p><p><strong>Methods: </strong>A multicenter cohort study including 1,331 singleton pregnancies between 11+2 and 34+6 weeks of gestation was conducted in the two participating centers to determine the performance of LSE as an aneuploidy marker. LSE was defined as a dichotomous marker using a newly defined axial plane of the fetal head in 2D ultrasound. Intra- and interobserver variability were assessed to ensure marker reliability. Efficacy in predicting chromosomal anomalies was assessed using LSE alone or in combination with aneuploidy screening.</p><p><strong>Results: </strong>A new axial plane of the fetal head, defined by both lenses and the cerebellum, was adopted for LSE detection. Intra-observer concordance Kappa index for LSE measurement was 1.0, and 0.82 for interobserver reliability. LSE could be assessed in 99% of the studied fetuses and was detected in 30 (2.3%) fetuses: in 19 (86%) of the 22 fetuses with chromosomal anomalies, in all cases (5/5, 100%) with other genetic anomalies, and in six (18%) of the 34 malformed fetuses without a genetic disorder. In one (3.3%) of the fetuses, LSE was not confirmed postnatally while the remaining 29 fetuses had an adverse outcome. When LSE was combined with aneuploidy screening, the detection rate of chromosomal anomalies remained the same and specificity increased from 89% to 100%.</p><p><strong>Conclusions: </strong>Our study supports using LSE as a potential 2D-ultrasound marker for chromosomal anomaly detection. Studies with a larger sample size and in high-risk populations are warranted to prove its clinical utility before this marker can be included in prenatal screening protocols. </p>.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"237-245"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12707868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of Dual Twin Survival after Laser for Twin-to-Twin Transfusion Syndrome.","authors":"Wael Abdallah, Marie-Aude Picard-Turcot, Isabelle Lafontaine-Trudel, Elisabeth Codsi, Sandrine Wavrant, Laurence Carmant, Marie-Josée Raboisson, Asma Khalil, François Audibert","doi":"10.1159/000547995","DOIUrl":"10.1159/000547995","url":null,"abstract":"<p><strong>Introduction: </strong>Twin-to-twin transfusion syndrome (TTTS) is associated with high perinatal morbidity and mortality. Krispin et al. [Ultrasound Obstet Gynecol. 2023;61(4):511-7] developed a prediction model to estimate the likelihood of dual twin survival after fetoscopic laser photocoagulation (FLPC). This study aimed to evaluate the predictive value of sonographic parameters at diagnosis of TTTS treated with FLPC for postnatal dual twin survival and to validate Krispin et al.'s calculator.</p><p><strong>Methods: </strong>This is a retrospective cohort study of cases of TTTS treated by FLPC. The primary outcome was dual survival 30 days after delivery. The calculator used preoperative variables: donor's estimated fetal weight (EFW) <10th centile, intertwin growth discordance >25%, anterior placenta, pulsatility index (PI) in the umbilical artery (UA), ductus venosus (DV), and middle cerebral artery (MCA), with scores ranging 0-300.</p><p><strong>Results: </strong>Among 157 patients, 84 (53.5%) had dual twin survival (Group A), compared to 73 (46.5%) with one or no survivors (Group B). No significant differences were seen in donor's EFW <10th centile (57.1% [A] vs. 57.5% [B], p = 0.96), intertwin growth discordance (26.2% [A] vs. 38.4% [B] p = 0.95), rates of PI >95th centile in the donor's UA and DV, and PI <5th centile in the MCA (p > 0.05). However, a significant difference was found for anterior placenta (38.1% [A] vs. 58.9% [B], p = 0.009). The observed dual survival was higher than predicted for scores ≥100.</p><p><strong>Conclusion: </strong>We were not able to externally validate the calculator of dual survival after laser for TTTS, especially for elevated scores. Among the parameters analyzed, only anterior placenta was significantly associated with poorer outcomes.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"60-68"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144948195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catheter-Based Foetal Cardiac Interventions: Literature Review.","authors":"Pak-Cheong Chow","doi":"10.1159/000551612","DOIUrl":"10.1159/000551612","url":null,"abstract":"<p><strong>Background: </strong>Foetal cardiac interventions (FCIs) represent a groundbreaking advancement in maternal-foetal medicine, offering therapeutic strategies to address congenital heart defects (CHDs) in utero.</p><p><strong>Summary: </strong>The indications, techniques, complications, and outcomes of the three most reported FCIs, namely, foetal aortic valvuloplasty, foetal pulmonary valvuloplasty, and foetal atrial septal intervention, were systematically reviewed based on the published literature. The challenges and future directions of this field were also highlighted.</p><p><strong>Key messages: </strong>FCIs open the therapeutic opportunity of several severe CHDs. However, the selection of cases for best outcome is yet to be refined due to lack of randomized controlled trial.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"483-502"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147503467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemoglobin Bart's Disease and the Agrinio Mutation: A Case Report of Successful Fetal Intervention.","authors":"Kobe Haenen, Emma Van den Eede, Jeroen Breckpot, Veerle Labarque, Gunnar Naulaers, Liesbeth Lewi, Roland Devlieger","doi":"10.1159/000551017","DOIUrl":"10.1159/000551017","url":null,"abstract":"<p><strong>Introduction: </strong>Hemoglobin Bart's hydrops fetalis syndrome (BHFS) is the most severe form of α-thalassemia, typically caused by homozygous deletion of α-globin genes. However, rare non-deletional variants, such as Hemoglobin (Hb) Agrinio, can also produce a lethal phenotype.</p><p><strong>Case presentation: </strong>We report a case of homozygous Hb Agrinio (HBA2:c.89T>C, p.Leu30Pro) diagnosed prenatally in a fetus of Bulgarian origin presenting with hydrops and severe anemia at 23 weeks of gestation. Following diagnosis, the pregnancy was managed with five intrauterine transfusions, resulting in resolution of hydrops and prolongation of pregnancy to term. The neonate was delivered at 37+3 weeks, required transient respiratory and cardiovascular support, and remains clinically stable at 3 months of age under regular transfusion therapy.</p><p><strong>Conclusion: </strong>To our knowledge, this is only the second reported case of BHFS resulting from homozygous Hb Agrinio successfully managed with intrauterine transfusions, and uniquely, the first to achieve term delivery. This case highlights the importance of considering unstable α-globin variants in the differential diagnosis of unexplained fetal hydrops in an at-risk population. Early diagnosis and timely intrauterine transfusions can significantly improve the perinatal outcomes in these cases.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"503-508"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146212675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fetal Intervention for Giant Chorangioma with Prenatal Ductus Arteriosus Closure: A Case Report.","authors":"Felicia V Lemoine, Natalie Neff, Sami Backley, Salima A Bhimani, Angela Bianco, Joanne Stone, Russell Miller, Anthony Johnson, Jimmy Espinoza, Rodrick C Zvavanjanja, Ramesha Papanna","doi":"10.1159/000551096","DOIUrl":"10.1159/000551096","url":null,"abstract":"<p><strong>Introduction: </strong>We present a case of spontaneous premature ductus arteriosus (DA) closure following modified interstitial laser ablation (ILA) of a giant chorangioma (GC) in a fetus with evidence of hydrops.</p><p><strong>Case presentation: </strong>A 26-week ultrasound revealed a 10-cm GC in the posteriorly located placenta with signs of fetal hydrops, polyhydramnios, and elevated middle cerebral artery peak systolic velocity (MCA PSV) of 1.9 MoM. Preoperative fetal echocardiogram showed elevated combined cardiac output (753 mL/kg/min) without structural abnormalities. Modified ILA targeting the branches of the feeder artery with an extended-pulse technique (30 s at 40 Watts) followed by intrauterine fetal transfusion was performed without complications. On postoperative day (POD) 1, new onset of ductus venosus flow reversal was noted, which was attributed to post-procedural hemodynamics. Fetal echocardiography on POD 5 suggested constriction of DA; follow-up confirmed complete DA closure and secondary right heart dysfunction. The pregnancy was managed expectantly with at least weekly echocardiograms. Digoxin and hyperoxygenation for fetal heart failure did not change DA caliber. Acetaminophen and fluoxetine were discontinued without improvement. After an uncomplicated term cesarean delivery (indication: breech), the female neonate was discharged home on day of life 3. Currently, the child is 6 months old and healthy.</p><p><strong>Conclusion: </strong>Modified ILA for GC followed by expectant management of associated DA closure yielded a term delivery with a favorable outcome.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"509-517"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147364531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intended vs. Actual Access to Care: Impact of Healthcare Consolidation on Maternal and Neonatal Outcomes.","authors":"Mark I Evans, Gregory F Ryan, Lawrence D Devoe, Jaqueline M Worth, David W Britt, George M Mussalli, Myriam Mondestin-Sorrentino, Christian R Macedonia","doi":"10.1159/000549187","DOIUrl":"10.1159/000549187","url":null,"abstract":"<p><strong>Introduction: </strong>The Affordable Care Act was intended principally to increase healthcare insurance coverage to uninsured Americans. Ostensibly, 40 million people obtained coverage. However, American maternal mortality has significantly worsened. The overall health curve in conservative leaning states is shifted downward in comparison to liberal ones including COVID mortality, maternal mortality, neonatal mortality, life expectancy, heart disease, pulmonary, and diabetic deaths, obesity, smoking, suicides, and alcohol related auto deaths. Here, we focus on insurance coverage issues related to those outcomes and market alterations produced by Affordable Care Act (ACA) legislation and regulatory actions that may or may not have had unintended consequences.</p><p><strong>Methods: </strong>Using authoritative national public databases, we analyzed 18 health status metrics in the context of Managed Care Organizations market consolidation and Accountable Care Organizations penetration fueled by the Medicaid expansion. We ranked states from best statistics to worst incorporating 10 measures of health access including: hospital beds, patients without examination for over a year, and incidence of maternity care deserts.</p><p><strong>Results: </strong>There is considerable variation in the USA for both healthcare status and access. Our data show these are highly correlated (r2 = 0.47, p < 0.01). States with the best outcomes have the best access. States with highest healthcare metrics and healthcare access were all traditional liberal \"blue states\" with greater infrastructure and insurance coverage.</p><p><strong>Conclusions: </strong>Hospital and clinic realignments created under the ACA appear to have worsened the healthcare of women and children in the USA, particularly for patients of color. Healthcare status and access to services are highly correlated. States allocating more resources for healthcare have better outcomes. Monopoly exemptions under ACA are temporally and statistically correlated with worsening of maternal outcomes across all geographic regions where control and consolidation was permitted or encouraged. Maternity care deserts have significantly disadvantaged women of color and working-class families in rural and urban zones. Further exacerbating the problem is the reduction of physician independence both within and outside of hospital systems.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"352-362"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145354202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of in utero Open Spina Bifida Repair Using a Laparotomy-Assisted Fetoscopic Approach on the Fetal Cardiovascular System.","authors":"Annika Albrecht, Justus G Reitz, Ivonne Bedei, Anita C Windhorst, Corinna Keil, Siegmund Köhler, Aline Wolter, Nicolas Schmitt, Gerald Kalmus, Benjamin Sass, Maximilian Schulze, Roland Axt-Fliedner","doi":"10.1159/000548623","DOIUrl":"10.1159/000548623","url":null,"abstract":"<p><strong>Introduction: </strong>Various treatment options for the prenatal open spina bifida (OSB) repair have evolved over the past decades, including the laparotomy-assisted fetoscopic repair. However, little is known about the fetal vascular regulation during the laparotomy-assisted fetoscopic repair. Therefore, we aimed to describe cardiovascular effects during the intervention in our cohort.</p><p><strong>Methods: </strong>A total of 26 fetuses underwent laparotomy-assisted fetoscopic repair at a single center between July 2021 and July 2024 and were prospectively included in this study. The intervention was performed using a three-port, three-layer fetoscopic repair of OSB via a laparotomy-assisted approach. Fetal heart rate (FHR) and pulsed-wave Doppler flow measurement of the pulsatility index (PI) in the umbilical artery (UA) and middle cerebral artery (MCA) were recorded at 13 defined time points throughout the surgery. The occurrence of absent or reverse end-diastolic (ARED) UA flow was documented. The MCA waveform was assessed for signs of fetal vasoconstriction (M-sign).</p><p><strong>Results: </strong>The mean gestational age at surgery was 25 weeks. A significant increase in the PI in the UA before laparotomy (PI: 1.22 ± 0.24) and after laparotomy (PI: 1.75 ± 0.37) was observed (p < 0.001). An ARED flow was recorded in 13.3% of cases after maternal general anesthesia, but not before and at the latest on the first day after surgery. MCA PI decreased nonsignificantly during the intervention. Before surgery, the M-sign was present in 6 fetuses; however, during surgery, it was seen only in 1 fetus. There were no significant changes in FHR during surgery except for a drop after gas insufflation (FHR: 129 ± 5; FHR: 125 ± 7.0, p < 0.001) compared to the FHR before surgery. During the postoperative course, the FHR increased significantly (day 0: 141 ± 10; day 4: 143 ± 9.8, p = 0.003).</p><p><strong>Conclusion: </strong>Our study shows changes in the UA PI and the occurrence of ARED during laparotomy-assisted fetoscopic repair. FHR remained stable during surgery. Furthermore, the findings confirm the transient nature of these changes. The occurrence of Doppler and waveform abnormalities was related to maternal-fetal anesthesia and the procedure itself.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"262-271"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}