Background Percutaneous partial amniotic carbon dioxide insufflation (PACI) is one of the most important means for improv - ing visualization during minimally invasive fetoscopic surgery of fetal spina bifida. The purpose of the present study was to analyze maternal and fetal safety aspects of PACI in a recent patient cohort and to present management improvements. Methods PACI under general materno-fetal anesthesia was performed during 65 interventions for fetoscopic patch cover- age of fetal spina bifida aperta between 21 + 0 and 29 + 1 weeks of gestation. Filtered carbon dioxide was insufflated into the amniotic cavity via three percutaneously introduced trocars. Maternal ventilatory and hemodynamic parameters during PACI as well as insufflation pressures, BMI, parity, and placental position were recorded and statistically analyzed in order to detect potential risk groups. Results Maternal respiration parameters during PACI showed a typical variation over time, which was similar in patients with BMI ≤ 25 or BMI > 25. The necessary insufflation pressures were significantly higher in nulliparae than multiparae. There was no statistically significant relationship between insufflation pressure and maternal BMI, or between the expired maternal carbon dioxide concentration (etCO ) and the placental position. PACI was safe for all mothers and fetuses.
Surgical Endoscopy – Springer Journals
Published: Jan 16, 2018
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