Fetoscopy

General

Core DX Study

Synonym/Acronym:
endoscopic fetal surgery, fetal endoscopy.

Rationale
To facilitate diagnosis and treatment of the fetus, evaluate for disorders such as neural tube defects and congenital defects, and assist with fetal karyotyping.

This Core Diagnostic Study is ordered in cases of high-risk pregnancies and is used to provide direct visualization for observation of a fetus, to facilitate collection of fetal blood or tissue samples, and to perform surgery on a fetus.

Patient Preparation
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.

Normal Findings

  • Absence of birth defects or findings that suggest presence of a birth defect

Critical Findings and Potential Interventions
N/A

Overview

(Study type: Endoscopy; related body system: Reproductive system.)

Fetoscopy is usually performed around the 18th wk 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.

Indications

  • Assess the fetus for birth defects during pregnancy; areas examined include the amniotic fluid, umbilical cord, and fetal side of the placenta.

Interfering Factors

  • 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

Nursing Implications, Nursing Process, Clinical Judgement

Potential Problems: Assessment & Nursing Diagnosis/Analysis

Problems Signs and Symptoms
Fear (related to ability to manage changes associated with disease; emotional response to clinical reality) States source of fear; apprehensive; withdrawn; jittery; nausea; noticeably tense; physiological changes with an increase in heart rate, blood pressure, pulse
Knowledge (insufficient related to lack of understanding, emotional response to disease process; lack of resources; poor memory) Failure to ask relevant questions; failed follow-through with instructions; altered behavior; inaccurate response to questions seeking knowledge confirmation

Before the Study: Planning and Implementation


Teaching the Patient What to Expect

  • Review the procedure with the patient.
  • Discuss how this procedure can assist in locating and treating fetal abnormalities.
  • Explain that the procedure takes approximately 60 min and is performed in an ultrasound department.

Procedural Information

  • Baseline vital signs are recorded and monitored throughout the procedure.
  • A local anesthetic is applied to the abdomen to ease with insertion of the fetoscope.
  • Positioning for this procedure is in the supine position.

Endoscopic Procedure

  • The lower abdominal area is cleaned, and a local anesthetic is administered in the area where the incision will be made.
  • Conductive gel is applied to the skin, and a Doppler transducer is moved over the skin to locate the position of the fetus. Ultrasound may be used.
  • The patient is advised to breathe normally during the examination.
  • If necessary for better fetal visualization, the patient is asked to inhale deeply and hold their breath.
  • Samples from aspirated amniotic fluid or fetal material are placed in the appropriate container(s) and labeled immediately after collection with the corresponding patient demographics: initials of the person collecting the specimen, date, and time of collection.
  • 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: Implementation & Evaluation Potential Nursing Actions


Avoiding Complications

  • Monitor the patient for complications related to the procedure.
  • Discuss the care of the incision and to contact their HCP immediately if experiencing chills, fever, dizziness, moderate or severe abdominal cramping, or fluid or blood loss from the vagina or incision.

Treatment Considerations

  • Follow postprocedure vital sign and assessment protocol.
  • Observe/assess the incision for redness or leakage of fluid or blood following the endoscopic procedure.

Fear

  • Facilitate management of fear.
  • Interventions/actions related to fear include the following: Identify the source of their fear. Respectfully acknowledge fear. Assess and facilitate positive coping strategies. Refer to support group specific to identified disease process.

Knowledge

  • Facilitate management of insufficient knowledge.
  • Interventions/actions related to insufficient knowledge include the following: Determine baseline understanding of disease and interventions. Assess willingness and ability to learn and implement instruction. Collaborate to identify priority learning needs. Facilitate instruction in a pleasant environment embracing openness, trust, and collaboration. Nonjudgmental attitude toward feelings associated with disease and lifestyle implications. Utilize a variety of instructional methods.

Clinical Judgement

  • Consider how to decrease the anxiety related to the fear of fetal abnormality.

Followup Evaluation and Desired Outcomes

  • Understands that a follow-up ultrasound will be completed the next day to assess the fetus and placenta.
  • Agrees to genetic counseling and screening as related to medical condition.