Endoscopic fetal surgery, fetal endoscopy.
To facilitate diagnosis and treatment of the fetus. Evaluate for disorders such as neural tube defects and congenital blood disorders, and assist with fetal karyotyping.
Area Of Application:
DescriptionFetoscopy is usually performed around the 18th week of pregnancy or later when the fetus is developed sufficiently for diagnosis of potential problems. It is done to evaluate or treat the fetus during pregnancy. Fetoscopy can be accomplished externally using a stethoscope with an attached headpiece, which is placed on the mother’s abdomen to assess the fetal heart tones. Endoscopic fetoscopy is accomplished using an instrument called a fetoscope, a thin, 1-mm flexible scope, which is placed with the aid of sonography. The fetoscope is inserted into the uterus through a thin incision in the abdominal wall (transabdominally) or through the cervix (transcervically) in earlier stages of pregnancy. Fetal tissue and blood samples can be obtained through the fetoscope. In addition, fetal surgery can be performed for such procedures as the repair of a fetal congenital diaphragmatic hernia, enlarged bladder, and spina bifida.
This procedure is contraindicated forN/A
- Assess the fetus for birth defects during pregnancy; areas examined include the amniotic fluid, umbilical cord, and fetal side of the placenta.
Normal Findings In:
- Absence of birth defects
Abnormal Findings In:
- Acardiac twin
- Congenital diaphragmatic hernia
- Neural tube defects
- Spinal bifida
Factors that may alter the results of the study
- Activity of fetus.
- Amniotic fluid that is extremely cloudy.
- Inability of patient to remain still during the procedure.
- Obesity or very overweight patient.
Nursing Implications Procedure
- Related tests include amniotic fluid analysis and L/S ratio, biopsy chorionic villus, blood groups and antibodies, chromosome analysis, culture bacterial anal/genital, culture viral, fetal fibronectin, α1-fetoprotein, hexosaminidase A and B, human chorionic gonadotropin, KUB, Kleihauer-Betke test, prolactin, MRI abdomen, and ultrasound biophysical profile obstetric.
- Refer to the Reproductive System Table for related test by body system.
- Positively identify the patient using at least two person-specific identifiers before services, treatments, or procedures are performed.
- Patient Teaching: Inform the patient this procedure can assist in locating and treating fetal abnormalities.
- Obtain a history of the patient’s health concerns, including a list of known allergens, especially allergies or sensitivities to latex, anesthetics, or sedatives.
- Obtain a history of the patient’s health concerns, symptoms, surgical procedures, and results of previously performed laboratory and diagnostic studies. Include a list of known allergens, especially allergies or sensitivities to latex.
- Record the date of last menstrual period and determine the age of the fetus.
- Obtain a list of the patient’s current medications, including over-the-counter medications and dietary supplements (see Effects of Dietary Supplements online at DavisPlus).
- Instruct the patient to remove jewelry and other metallic objects in the area to be examined.
- Review the procedure with the patient. Address concerns about pain and explain that a local anesthetic will be applied to the abdomen to ease with insertion of the fetoscope. Inform the patient that the procedure is performed in an ultrasound department, by a health-care provider (HCP) specializing in this procedure, with support staff, and takes approximately 60 min.
- Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
- Instruct patient that food and fluid should be withheld for 8 hr prior to the endoscopic procedure. There are no medication restrictions unless by medical direction.
- Make sure a written and informed consent has been signed prior to the procedure and before administering any medications.
- Ensure that the patient has complied with dietary restrictions prior to the study, as instructed.
- Ensure that the patient has removed external metallic objects prior to the procedure.
- Instruct the patient to void prior to the procedure and to change into the gown, robe, and foot coverings provided.
- Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
- Instruct the patient to cooperate fully and to follow directions. Instruct the patient to remain still throughout the procedure because movement produces unreliable results.
- Instruct the patient to lie on her back.
- Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection online at DavisPlus. Positively identify the patient.
- The lower abdomen area is cleaned, and a local anesthetic is administered in the area where the incision will be made. Label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection if samples are to be obtained on aspirated amniotic fluid or fetal material.
- Conductive gel is applied to the skin, and a Doppler transducer is moved over the skin to locate the position of the fetus.
- Ask the patient to breathe normally during the examination. If necessary for better fetal visualization, ask the patient to inhale deeply and hold her breath.
- Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
- When the study is completed, remove the gel from the skin.
- Observe/assess the incision for redness or leakage of fluid or blood following the endoscopic procedure.
- Instruct the patient in the care of the incision and to contact her HCP immediately if she is experiencing chills, fever, dizziness, moderate or severe abdominal cramping, or fluid or blood loss from the vagina or incision.
- Inform the patient that a follow-up ultrasound will be completed the next day to assess the fetus and placenta.
- Recognize anxiety related to test results. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate.
- Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
- Depending on the results of this procedure, additional testing may be needed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.
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