AMINOSCOPY AND FETOSCOPY
PRESENTED BY
SIVAGAMI. G
M.SC(N) 1 ST YEAR
AMINOSCOPY
INTRODUCTION
aminoscopy is an invasive exam
employed to visualize the forebag of the
amnionic sac to look out for meconium
staining. The concept of finding meconium
stained fluid being correlated to increased
risk of fetal distress and perinatal mortality.
Ideally , it should serve to verify presence of
fluid with its amount and verify its quality.
DEFINITION
Examination of a fetus and the
amniotic fluid in the lowest part of
the amniotic sac using an aminoscope
introduced through the cervical canal.
USES
To monitor the amniotic fluid of the fetus.
To visualize the fetus.
To sample amniotic fluid or fetal blood.
Used for monitoring during late
pregnancy and birth.
AMNIOSCOPE PROCEDURE
INDICATIONS
Pathological CTG during childbirth.
Repetition of fetal blood analysis based
on blood gas values.
Compromised fetus in the case of stalled
labour.
CONTRAINDICATIONS
Severe fetal bradycardia
Prolonged deceleration > 3 min
Maternal infections[eg: HIV, Hep A, C, herpes]
Fetal congenital coagulation disorders[eg:
hemophillia]
Premature birth [ < 34 weeks]
Closed or insufficiently open cervix
Other highly pathological CTG patterns[eg:
sinusoidal pattern]
End of expulsion stage.
CLASSIFICATIONS PROGNOSTIC INTERVENTION
SIGNIFICANCE
1. LIMPID: CLASSIFICATION Fetal well being Observation (monitor and
limpid and in normal wait for spontaneous
quantities labour)
2.GRADE 1 MECONIUM: Possible fetal Immediate delivery
Light meconium staining, compromise CTG- normal –
with amniotic fluid in normal spontanoeus labour.
quantities CTG – abnormal- LSCS
3.GRADE 2 MECONIUM Possible fetal Immediate delivery
STAINING: comprosie CTG normal- spontanoeus
Thickly stained of meconium, labour
reduced volume of the CTG abnormal- LSCS
amniotic fluid
4.GRADE 3 MECONIUM pathological Immediate delivery by
STAINING; caesearian section
pea – soup meconium
5.ABSENT : Possible fetal Immediate delivery
Amniotic fluidnot compromise
evaluatable
INSTRUMENTS USED
Outer sheath
Obturator
Sponge forceps
Forceps insert
Light deflector with adjustable magnifier.
COMPLICATIONS
SEPSIS
RUPUTURE OF MEMBRANES
FETOSCOPY
INTRODUCTION
A fibreoptic instrument that can be
passed through abdomen of a pregnant
woman to enable examination of the fetus
and withdrawal of blood for sampling in
prenatal diagnosis.
DEFINITION
Fetoscopy in which the fetus is visualized
by inspection through a fetoscope [ an
extremely narrow, hallow tube inserted by
amniocentesis technique], can be helpful
to assess fetal well being.
-LOPRIORE ET AL., 2007.
USES
1. Confirm the intactness of the spinal
column.
2. Obtain biopsy samples of fetal tissue and
fetal blood samples.
3. Perform elemental surgery, such as
inserting polyethylene shunt into the
fetal ventricles to relieve hydrocephalus
or anteriorly into the fetal bladder to
relieve a stenosed urethra.
TIMING TO PERFORM
Fetoscopy is a procedure done during or
after the 18 th week of pregnancy.
Because the structures of the placenta and
the fetus are developed well enough to be
able to diagnose any serious problem.
PROCEDURE
The fetus is seen
through a small
incision made in
the belly , and a
fetal ultrasound
guides the
placement of the
fetoscope.
A camera can be
attached to the
fetoscope to take
pictures.
INDICATIONS
Mothers who are having first baby after
the age of 35.
Family history indicating genetic
abnormality.
Abnormal ultra sound findings.
Consanguinous marriage.
THE MOST COMMON CONDITIONS
TREATEDWITH FETOSCOPY ARE:
1. TWIN TO TWIN TRANSFUSION
SYNDROME
When identical twins aren’t getting an equal
share of blood while in the womb.
Using fetoscopy to better visualize the 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.
FETOSCOPIC LASER
PHOTOCOAGULATION
AMNIOTIC BAND
SYNDROME
Contd..
2. AMNIOTIC BAND SYNDROME
Amniotic band syndrome occurs
when the baby gets tangled up in
bands of tissue from the amniotic
sac.
It can restrict blood flow or cause
amputation of limps or organs.
A fetoscope allows to insert a
laser device that cuts and
releases the bands of tissue
3.CONGENITAL DIAPHAGMATIC
HERNIA[CDH]
CDH occurs when the baby has a hole in
the diaphargm, which causes its
abdominal organs to shuft upwards,
putting pressure on the lungs.
Thus prevents their lungs from growing
properly.
Fetoscopy is used to insert a balloon in the
baby’s airway to promote lung growth.
The balloon is removed several weeks
later.
This procedure is called [FETO] fetoscopic
endoluminal tracheal occulsion.
CDH BY FETO PROCEDURE
PERFORMING A
FETOSCOPY
BEFORE
The fetus heart rate will be checked.
Mother may be given a sedative.
Place the mother on supine position.
DURING
The mother will be on her back with her
stomach muscles relaxed.
An injection will be given in the lower abdomen
to numb the skin where the fetoscope will be
inserted.
PERFORMING A FETOSCOPY
CONTD..
An ultrasound will be used to determine
the position of both fetus and the placenta.
The ultrasound is used as a picture guide
sothe doctor can determine where to make
the incision.
Once the fetoscope is in place the doctor
can look at the fetus, collect blood and
skin samples, and operate if necessary.
Performing a fetoscopy
cont..
AFTER
The fetoscope is removed and the incision is
closed.
Another fetal ultrasound will be done check fetal
movement and to evaluate the amount of amniotic
fluid.
Mother and fetus are monitored for several hours,
to ensure everything is back to normal.
The next day, the ultrasound will be repeated
once more to the check the fetus and the placenta.
COMPLICATIONS
Miscarriage , as high as 12%
Excessive bleeding, infection, or
excessive leakage of the amniotic
fluid.
Preterm rupture of the
membranes.
Mixing mother’s blood with
baby’s blood.
THANK YOU
