Partial amniotic carbon dioxide insufflation (PACI) during minimally invasive fetoscopic interventions on fetuses with spina bifida aperta

Partial amniotic carbon dioxide insufflation (PACI) during minimally invasive fetoscopic... 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. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Surgical Endoscopy Springer Journals

Partial amniotic carbon dioxide insufflation (PACI) during minimally invasive fetoscopic interventions on fetuses with spina bifida aperta

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Publisher
Springer Journals
Copyright
Copyright © 2018 by Springer Science+Business Media, LLC, part of Springer Nature
Subject
Medicine & Public Health; Surgery; Gynecology; Gastroenterology; Hepatology; Proctology; Abdominal Surgery
ISSN
0930-2794
eISSN
1432-2218
D.O.I.
10.1007/s00464-018-6029-z
Publisher site
See Article on Publisher Site

Abstract

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.

Journal

Surgical EndoscopySpringer Journals

Published: Jan 16, 2018

References

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