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Partial amniotic carbon dioxide insufflation for fetal surgery |
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| Authors: | Sasha Skinner Philip DeKoninck Kelly Crossley Benjamin Amberg Jan Deprest Stuart Hooper Ryan Hodges |
| Institution: | 1. The Ritchie Centre, Hudson Institute for Medical Research, Clayton, Australia;2. The Ritchie Centre, Hudson Institute for Medical Research, Clayton, Australia
Perinatal Services Monash Health, Monash Medical Centre, Clayton, Australia;3. The Ritchie Centre, Hudson Institute for Medical Research, Clayton, Australia Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia;4. Division of Woman and Child, Department of Obstetrics & Gynaecology, University Hospitals Leuven, Leuven, Belgium Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium Institute for Women's Health, University College London, London, UK |
| Abstract: | Partial amniotic carbon dioxide insufflation (PACI) involves insufflating the amniotic sac with carbon dioxide (CO2) and, in some cases, draining some of the amniotic fluid. The creation of a gaseous intra-amniotic compartment improves visualization, even in the presence of limited bleeding, and creates the work space required for complex fetoscopic procedures. Clinically, PACI is mostly used to perform fetoscopic myelomeningocele (MMC) repair, enabling a minimally invasive alternative to open fetal surgery. However, evidence of the fetal safety of PACI is limited. Previous animal experiments in sheep demonstrate that PACI induces fetal hypercapnia and acidosis with largely unknown short and longer term implications. In this review, we examine the literature for the physiological effects of intrauterine insufflation pressure, duration, humidity, and the role of maternal hyperventilation on fetal physiology and well-being. |
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