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.
Instruct the patient to withhold food and fluid for 8 hr prior to the endoscopic procedure. There are no activity or medication restrictions unless by medical direction.
- Absence of birth defects or findings that suggest presence of a birth defect
Critical Findings and Potential Interventions
Overview(Study type: Endoscopy; related body system: Reproductive system.) Fetoscopy 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.
- Assess the fetus for birth defects during pregnancy; areas examined include the amniotic fluid, umbilical cord, and fetal side of the placenta.
Factors that may alter the results of the study
- Activity of fetus.
- Amniotic fluid that is extremely cloudy.
Potential Medical Diagnosis: Clinical Significance of Results
Abnormal Findings In:
- Acardiac twin
- Congenital diaphragmatic hernia
- Neural tube defects
- Spinal bifida
Before the Study: Planning and Implementation
Teaching the Patient What to Expect
- Inform the patient this procedure can assist in locating and treating fetal abnormalities.
- 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.
- The patient will be instructed to lie on her back for this procedure.
- 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.
- The patient will be asked to breathe normally during the examination. If necessary for better fetal visualization, the patient will be asked to inhale deeply and hold her breath.
- When the study is completed, the gel is removed from the skin.
Potential Nursing Actions
Make sure a written and informed consent has been signed prior to the procedure and before administering any medications.
After the Study: Potential Nursing Actions
- 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.
- Observe/assess the incision for redness or leakage of fluid or blood following the endoscopic procedure.
Followup Evaluation and Desired Outcomes
- Understands that a follow-up ultrasound will be completed the next day to assess the fetus and placenta.
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