Robert Ball's research while affiliated with St. Mark's Hospital and other places

Introduction Fetoscopic release of amniotic bands has proved its life- and limb-saving potential. Rupture of the amnion and separation of chorion from the amnion and uterine wall can however preclude the standard fetoscopic approach to release the amniotic bands using a single port. Methods and Materials A 28-year-old G1P0 woman was referred to our unit at 19 weeks due to amniotic band syndrome involving the left ankle, the infrapatellar region of the right leg, and the umbilical cord. Of note, part of the fetus was seen outside the amniotic cavity by ultrasonography and the left ankle and foot were severely swollen. The patient underwent a laparotomy and fetoscopic release of the amniotic bands as well as partial amnionectomy using two uterine ports and CO2 as distention. Results The surgery and postoperative recovery course were uneventful. At 341/7 weeks the patient went into labor, which was augmented resulting vaginal delivery of a 2,460-g male infant. The infant was noted to have a shallow skin indentation on the left lower extremity near the ankle. The infant was discharged in excellent condition. Conclusion In those cases where release of an amniotic band is impossible due to membrane separation, surgery in a CO2-filled uterus offers an option.

Limb constriction is an unusual complication of a double pigtail shunt. We report here a case of a threatened upper limb from a pleuro-amniotic shunt and its fetoscopic management. A 35 year old G6P4 patient was referred at 21-4/7 weeks for management of bilateral fetal pleural effusions and non-immune hydrops. Bilateral Rocket catheters were uneventfully placed and the fetus responded well. At 28 weeks it was noted that the amniotic end of one of the shunts was encircling the fetal left upper arm. Over the next 2 weeks there was progressive worsening of the constriction with a deep indentation completely surrounding the arm and causing distal edema. A plastic surgeon recommended release of the constriction to prevent superficial nerve damage and possible vascular consequences. An extensive anterior placenta prevented direct fetoscopic access to the fetus and for this reason the patient underwent a laparotomy to allow fetoscope placement. When single port fetoscopy under amniotic fluid proved insufficient, a two-port, in-CO2 fetoscopic approach was used. The surgery and postoperative recovery were uneventful and the patient was discharged at 96 hrs for outpatient follow-up. At 38-2/7 weeks the patient had an uncomplicated induction of labor and vaginal delivery. The baby was admitted to the NICU for management of the pleural effusions and was ultimately discharged home in good condition. This new 2-port, in-CO2, fetoscopic approach may offer an option for more complex surgical procedures in life and/or limb saving situations. This article is protected by copyright. All rights reserved.