TY - JOUR
T1 - Fetal blood gases after in utero carbon dioxide insufflation for percutaneous fetoscopic spina bifida repair
AU - Sangara, Rauvynne N.
AU - Chon, Andrew H.
AU - Van Speybroeck, Alexander L.
AU - Chu, Jason K.
AU - Llanes, Arlyn S.
AU - Kontopoulos, Eftichia V.
AU - Quintero, Rubén A.
AU - Chmait, Ramen H.
N1 - Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/9
Y1 - 2021/9
N2 - BACKGROUND: Prenatal repair of open spina bifida via the percutaneous fetoscopic approach does not require maternal laparotomy, hysterotomy, or exteriorization of the uterus. This technique requires intrauterine partial CO2 insufflation. Limited data exist on the physiological effects of CO2 insufflation on human fetuses, with no data on open spina bifida repair performed using the entirely percutaneous fetoscopic surgical technique. OBJECTIVE: Our aim was to examine the effects of intrauterine partial CO2 insufflation on fetal blood gases after percutaneous fetoscopic open spina bifida repair. STUDY DESIGN: This was a prospective study of patients who underwent percutaneous fetoscopic open spina bifida repair from February 2019 to July 2020. Fetal cordocentesis of the umbilical vein was performed in cases with favorable access to the umbilical cord. The umbilical vein cord blood samples were obtained under ultrasound guidance immediately at the conclusion of the open spina bifida repair. Simultaneous maternal arterial blood gas samples were also obtained. The results are reported as median (range). RESULTS: Of the 20 patients who underwent percutaneous fetoscopic open spina bifida repair during the study period, 7 patients (35%) underwent fetal blood sampling. The gestational age at the time of surgery was 27.4 (24.0–27.9) weeks and the operative time was 183 (156–251) minutes. The CO2 exposure time was 122 (57–146) minutes with maximum pressure of 13.5 (12.0–15.0) mm Hg. Fetal umbilical vein results were as follows: pH 7.35 (7.30–7.39), partial pressure of O2 56.2 (47.1–99.9) mm Hg, partial pressure of CO2 43.8 (36.2–53.0) mm Hg, HCO3 23.9 (20.1–25.6) mmol/L, and base excess −2.2 (−4.5 to −0.4) mmol/L. Simultaneous maternal arterial blood gas results were as follows: pH 7.37 (7.28–7.42), partial pressure of O2 187.5 (124.4–405.2) mm Hg, partial pressure of CO2 36.6 (30.7–46.0) mm Hg, HCO3 21.3 (18.0–22.8) mmol/L and base excess −3.2 (−5.9 to −1.8) mmol/L. CONCLUSION: Despite prolonged CO2 insufflation of the uterus, fetal umbilical vein pH and base excess values did not approach those associated with potentially pathologic fetal acidemia.
AB - BACKGROUND: Prenatal repair of open spina bifida via the percutaneous fetoscopic approach does not require maternal laparotomy, hysterotomy, or exteriorization of the uterus. This technique requires intrauterine partial CO2 insufflation. Limited data exist on the physiological effects of CO2 insufflation on human fetuses, with no data on open spina bifida repair performed using the entirely percutaneous fetoscopic surgical technique. OBJECTIVE: Our aim was to examine the effects of intrauterine partial CO2 insufflation on fetal blood gases after percutaneous fetoscopic open spina bifida repair. STUDY DESIGN: This was a prospective study of patients who underwent percutaneous fetoscopic open spina bifida repair from February 2019 to July 2020. Fetal cordocentesis of the umbilical vein was performed in cases with favorable access to the umbilical cord. The umbilical vein cord blood samples were obtained under ultrasound guidance immediately at the conclusion of the open spina bifida repair. Simultaneous maternal arterial blood gas samples were also obtained. The results are reported as median (range). RESULTS: Of the 20 patients who underwent percutaneous fetoscopic open spina bifida repair during the study period, 7 patients (35%) underwent fetal blood sampling. The gestational age at the time of surgery was 27.4 (24.0–27.9) weeks and the operative time was 183 (156–251) minutes. The CO2 exposure time was 122 (57–146) minutes with maximum pressure of 13.5 (12.0–15.0) mm Hg. Fetal umbilical vein results were as follows: pH 7.35 (7.30–7.39), partial pressure of O2 56.2 (47.1–99.9) mm Hg, partial pressure of CO2 43.8 (36.2–53.0) mm Hg, HCO3 23.9 (20.1–25.6) mmol/L, and base excess −2.2 (−4.5 to −0.4) mmol/L. Simultaneous maternal arterial blood gas results were as follows: pH 7.37 (7.28–7.42), partial pressure of O2 187.5 (124.4–405.2) mm Hg, partial pressure of CO2 36.6 (30.7–46.0) mm Hg, HCO3 21.3 (18.0–22.8) mmol/L and base excess −3.2 (−5.9 to −1.8) mmol/L. CONCLUSION: Despite prolonged CO2 insufflation of the uterus, fetal umbilical vein pH and base excess values did not approach those associated with potentially pathologic fetal acidemia.
KW - carbon dioxide insufflation
KW - fetal acidemia
KW - fetal hypercapnia
KW - fetal surgery
KW - myelomeningocele repair
KW - open spina bifida
KW - partial amniotic carbon dioxide insufflation (PACI)
KW - percutaneous fetoscopy
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U2 - 10.1016/j.ajogmf.2021.100409
DO - 10.1016/j.ajogmf.2021.100409
M3 - Article
C2 - 34058420
AN - SCOPUS:85116173132
SN - 2589-9333
VL - 3
JO - American Journal of Obstetrics and Gynecology MFM
JF - American Journal of Obstetrics and Gynecology MFM
IS - 5
M1 - 100409
ER -