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Morbidity still a concern in fetal surgeries.(Obstetrics)
RENO, NEV. -- Newer, less invasive techniques have decreased morbidity associated with fetal surgery, but morbidity is still a concern in these surgeries, Robert H. Bell, M.D., said at the annual meeting of the Society for Maternal-Fetal Medicine.
The morbidity data come from a retrospective study of all fetal surgeries at the University of California, San Francisco, between July 1985 and May 2003, said Dr. Bell of the university.
During the early days of fetal surgery, most of the procedures involved open hysterotomy. Then fetal endoscopy (FETENDO) became popular, and now ultrasound-guided radiofrequency ablation (RFA) is the dominant procedure.
In all, 187 women with a mean maternal age of 29 (range 19-43) were treated during this period. Nine cases were marked by procedure-related fetal demise. Of the remaining 178 procedures, 79 involved a laparotomy and hysterotomy, 68 involved FETENDO, and 31 involved RFA.
Indications for the procedures included congenital diaphragmatic hernia in 38% of cases, monochorionic twin complications in 31%, hydrops in 11.8%, meningomyelocele in 8.6%, teratomas in 6.4%, and urinary obstruction in 2.1%.
The average gestational age for both hysterotomy and FETENDO was about 25 weeks, but RFA was done significantly earlier, at an average gestational age of about 21 weeks.
There were no significant differences in gestational age at delivery, with hysterotomy patients delivering at an average of 30.1 weeks, FETENDO patients delivering at 30.4 ...
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