PARTICULAR ISSUES OF FETAL SURGERY
Abstract
The high incidence of severe forms of congenital malformations of various localizations, complications developing in utero, unsatisfactory rates of antenatal, neonatal and infant mortality, and disability of the child population determine the relevance of the topic under consideration. Despite modern capabilities and such worthy results of the work of the neonatal surgical service, there are defects, the correction of which even in the first hours and days after birth does not allow subsequently to fully restore the function of the organ and the functioning of the system as a whole. Prenatal treatment of fetal anomalies is a new direction in medicine. Intrauterine interventions can not only stop the progressive development of pathology, but also reduce the degree of damage to nearby tissues, and in some cases, completely eliminate the anatomical defect while maintaining functional potential. The purpose of the review was to analyze the literature on the current state of fetal surgery for specific pathological conditions of the fetus. The results of more than two hundred works from the following medical databases were studied: PubMed, Web of Science, MEDLINE, Scopus. The main methods of intrauterine intervention for obstructive uropathy, diaphragmatic hernia, spina bifida, sacrococcygeal teratoma are described. Possible risks for the mother and fetus, as well as measures to minimize them, are considered. The results of the work of the largest foreign and domestic neonatal surgery centers are presented, as well as the opinions of various specialists in this field regarding the feasibility and prospects of fetal interventions. Information about new directions in the correction of congenital malformations in utero is presented.
References
Wojcik M.H., Agrawal P.B. Deciphering congenital anomalies for the next generation. Cold Spring Harb Mol Case Stud. 2020;6(5):a005504. DOI: 10.1101/mcs.a005504.
Narapureddy B.R., Zahrani Y., Alqahtani H.E.M. et al. Examining the Prevalence of Congenital Anomalies in Newborns: A Cross-Sectional Study at a Tertiary Care Maternity Hospital in Saudi Arabia. Children (Basel). 2024;11(2):188. DOI: 10.3390/children11020188.
Garcia-Herrero S., Simon B., Garcia-Planells J. The Reproductive Journey in the Genomic Era: From Preconception to Childhood. Genes (Basel). 2020;11(12):1521. DOI: 10.3390/genes11121521.
Kannane S., Boussaa S., Mendili J.E., Touloun O. Congenital Malformations in the Moroccan Surveillance System: Contribution to Prevalence Estimation. Glob Health Epidemiol Genom. 2024;2024:9570798. DOI: 10.1155/2024/9570798.
Sharma D., Tsibizova V.I. Current perspective and scope of fetal therapy, part 1. J Matern Fetal Neonatal Med. 2022;35(19):3783–3811. DOI: 10.1080/14767058.2020.1839880.
Jeanty C., Derderian S.C., Mackenzie T.C. Maternal-fetal cellular trafficking: clinical implications and consequences. Curr Opin Pediatr. 2014;26(3):377–82. DOI: 10.1097/MOP.0000000000000087.
Arora M., Prasad A., Kulshreshtha R., Baijal A. Significance of third trimester ultrasound in detecting congenital abnormalities of kidney and urinary tract-a prospective study. J Pediatr Urol. 2019;15(4):334–340. DOI: 10.1016/j.jpurol.2019.03.027.
Чечнева М.А., Титченко Ю.П., Лысенко С.Н. Клиническое значение ультразвукового исследования околоплодных вод. Российский вестник акушера-гинеколога. 2013;13(1):12–16.
Paraboschi I., Giannettoni A., Mantica G. et al. Posterior Urethral Valves, Unilateral Vesicoureteral Reflux, and Renal Dysplasia (VURD) Syndrome: Long-Term Longitudinal Evaluation of the Kidney Function. Int J Environ Res Public Health. 2023;20(13):6238. DOI: 10.3390/ijerph20136238.
Evans L.L., Harrison M.R. Modern fetal surgery-a historical review of the happenings that shaped modern fetal surgery and its practices. Transl Pediatr. 2021;10(5):1401–1417. DOI: 10.21037/tp-20-114.
Morris R.K., Malin G.L., Quinlan-Jones E. et al. Percutaneous vesicoamniotic shunting in Lower Urinary Tract Obstruction (PLUTO) Collaborative Group. Percutaneous vesicoamniotic shunting versus conservative management for fetal lower urinary tract obstruction (PLUTO): a randomised trial. Lancet. 2013;382(9903):1496–506. DOI: 10.1016/S0140-6736(13)60992-7.
Nassr A.A., Shazly S.A.M., Abdelmagied A.M. et al. Effectiveness of vesicoamniotic shunt in fetuses with congenital lower urinary tract obstruction: an updated systematic review and metaanalysis. Ultrasound Obstet. Gynecol. 2017;49(6):696–703. DOI: 10.1002/uog.15988.
Bañuelos Marco B., González R., Ludwikowski B., Lingnau A. Effectiveness of prenatal intervention on the outcome of diseases that have a postnatal urological impact. Front Pediatr. 2019;7:118. DOI: 10.3389/fped.2019.00118.
Косовцова Н.В., Куклин Е.С., Фёдорова Н.А. Новый взгляд на тактику ведения пациенток с обструктивными уропатиями плода. Доктор.Ру. 2023;22(5):26–33. DOI: 10.31550/1727-2378-2023-22-5-26-33.
Meller C., Covini D., Aiello H. et al. Update on prenatal diagnosis and fetal surgery for myelomeningocele. Arch Argent Pediatr. 2021;119(3):e215–e228. English, Spanish. DOI: 10.5546/aap.2021.eng.e215.
Sampat K., Losty P.D. Fetal surgery. Br J Surg. 2021;108(6):632–637. DOI: 10.1093/bjs/znaa153.
Sacco A., Ushakov F., Thompson D. et al. Fetal surgery for open spina bifida. Obstet Gynaecol. 2019;21(4):271–282. DOI: 10.1111/tog.12603.
Agrawal S., Al-Refai A., Abbasi N. et al. Correlation of fetal ventricular size and need for postnatal cerebrospinal fluid diversion surgery in open spina bifida. Ultrasound Obstet Gynecol. 2022;59(6):799–803. DOI: 10.1002/uog.24767.
Danzer E., Joyeux L., Flake A.W., Deprest J. Fetal surgical intervention for myelomeningocele: lessons learned, outcomes, and future implications. Dev Med Child Neurol. 2020;62(4):417–425. DOI: 10.1111/dmcn.14429.
Donepudi R., Brock C., Schulte S. et al. Trend in ventricle size during pregnancy and its use for prediction of ventriculoperitoneal shunt in fetal open neural tube defect. Ultrasound Obstet Gynecol. 2020;56(5):678–683. DOI: 10.1002/uog.21928.
Goodnight W.H., Bahtiyar O., Bennett K.A. et al. fMMC Consortium sponsored by NAFTNet. Subsequent pregnancy outcomes after open maternal-fetal surgery for myelomeningocele. Am J Obstet Gynecol. 2019;220(5):494.e1–494.e7. DOI: 10.1016/j.ajog.2019.03.008.
Soni S., Moldenhauer J.S., Spinner S.S. et al. Chorioamniotic membrane separation and preterm premature rupture of membranes complicating in utero myelomeningocele repair. Am J Obstet Gynecol. 2016;214(5):647.e1–7. DOI: 10.1016/j.ajog.2015.12.003.
Hirst A., Philippou Y., Blazeby J. et al. No Surgical Innovation Without Evaluation: Evolution and Further Development of the IDEAL Framework and Recommendations. Ann Surg. 2019;269(2):211–220. DOI: 10.1097/SLA.0000000000002794.
Olutoye O.O., Joyeux L., King A. et al. Minimally Invasive Fetal Surgery and the Next Frontier. Neoreviews. 2023;24(2):e67–e83. DOI: 10.1542/neo.24-2-e67.
Cruz-Martínez R., Chavelas-Ochoa F., Martínez-Rodríguez M. et al. Open Fetal Microneurosurgery for Intrauterine Spina Bifida Repair. Fetal Diagn Ther. 2021;48(3):163–173. DOI: 10.1159/000513311.
Pedreira D.A.L., Zanon N., Nishikuni K. et al. Endoscopic surgery for the antenatal treatment of myelomeningocele: the CECAM trial. Am J Obstet Gynecol 2016;214:111.e1–111.e11. DOI: 10.1016/j.ajog.2015.09.065.
Watanabe M., Li H., Kim A.G. et al. Complete tissue coverage achieved by scaffold-based tissue engineering in the fetal sheep model of Myelomeningocele. Biomaterials. 2016;76:133–43. DOI: 10.1016/j.biomaterials.2015.10.051.
Shieh H.F., Ahmed A., Rohrer L. et al. Donor mesenchymal stem cell linetics after transamniotic stem cell therapy (TRASCET) for experimental spina bifida. J Pediatr Surg. 2018;53(6):1134–1136. DOI: 10.1016/j.jpedsurg.2018.02.067.
Vasudev R.B., Kumar N., Gadgade B.D. et al. Factors contributing to mortality in neonates with congenital diaphragmatic hernia and eventration. Afr J Paediatr Surg. 2023;20(2):85–88. DOI: 10.4103/ajps.ajps_165_21.
Dick J.R., Wimalasundera R., Nandi R. Maternal and fetal anaesthesia for fetal surgery. Anaesthesia. 2021;76(Suppl 4):63–68. DOI: 10.1111/anae.15423.
Marks K.T., Landis M.W., Lim F.Y. et al. Evaluation of Lung Injury in Infants with Congenital Diaphragmatic Hernia. J Pediatr Surg. 2019;54(11):2443–2447. DOI: 10.1016/j.jpedsurg.2019.06.016.
Losty P.D. Congenital diaphragmatic hernia: where and what is the evidence? Semin Pediatr Surg. 2014;23(5):278–82. DOI: 10.1053/j.sempedsurg.2014.09.008.
Perrone E.E., Deprest J.A. Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: a narrative review of the history, current practice, and future directions. Transl Pediatr. 2021;10(5):1448–1460. DOI: 10.21037/tp-20-130.
Basurto D., Russo F.M., Van der Veeken L. et al. Prenatal diagnosis and management of congenital diaphragmatic hernia. Best Pract Res Clin Obstet Gynaecol. 2019;58:93–106. DOI: 10.1016/j.bpobgyn.2018.12.010.
Kiani A.K., Paolacci S., Scanzano P. et al. Prenatal genetic diagnosis: Fetal therapy as a possible solution to a positive test. Acta Biomed. 2020;91(13-S):e2020021. DOI: 10.23750/abm.v91i13-S.10534.
Deprest J.A., Nicolaides K.H., Benachi A. et al.
TOTAL Trial for Severe Hypoplasia Investigators. Randomized Trial of Fetal Surgery for Severe Left Diaphragmatic Hernia. N Engl J Med. 2021;385(2):107–118. DOI: 10.1056/NEJMoa2027030.
Chen Y., Xu R., Xie X. et al. Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2023;61(6):667–681. DOI: 10.1002/uog.26164.
Taguchi T. Sacrococcygeal teratoma: Nationwide survey and guidelines. Pediatr Int. 2019;61(7):633. DOI: 10.1111/ped.13933.
Kremer M.E.B., Althof J.F., Derikx J.P.M. et al. The incidence of associated abnormalities in patients with sacrococcygeal teratoma. J Pediatr Surg. 2018;53(10):1918–1922. DOI: 10.1016/j.jpedsurg.2018.01.013.
Marcu M.L., Bacalbaşa N., Candrea E. et al. Fetal sacrococcygeal immature teratoma — report of two cases and review of the literature. Rom J Morphol Embryol. 2022;63(1):203–207. DOI: 10.47162/RJME.63.1.22.
Cass D.L. Fetal abdominal tumors and cysts. Transl Pediatr. 2021;10(5):1530–1541. DOI: 10.21037/tp-20-440.
Zvizdic Z., Jonuzi A., Milisic E. et al. A Long-Term Outcome of the Patients with Sacrococcygeal Teratoma: A Bosnian Cohort. Turk Arch Pediatr. 2023;58(2):168–173. DOI: 10.5152/TurkArchPediatr.2023.22268.
Kramer K.P., Chetty S.P., Nawaytou H. et al. Fetal Sacrococcygeal Teratoma and the Development of Hydrops. Neoreviews. 2021;22(2):e141–e147. DOI: 10.1542/neo.22-2-e141.
Lee M.Y., Won H.S., Hyun M.K. et al. Perinatal outcome of sacrococcygeal teratoma. Prenat Diagn. 2011;31(13):1217–21. DOI: 10.1002/pd.2865.
Ruano R., Duarte S., Zugaib M. Percutaneous laser ablation of sacrococcygeal teratoma in a hydropic fetus with severe heart failure — too late for a surgical procedure? Fetal Diagn Ther. 2009;25(1):26–30. DOI: 10.1159/000188663.
Partridge E.A., Canning D., Long C. et al. Urologic and anorectal complications of sacrococcygeal teratomas: prenatal and postnatal predictors. J Pediatr Surg. 2014;49(1):139–42; discussion 142-3. DOI: 10.1016/j.jpedsurg.2013.09.042.
Башмакова Н.В., Косовцова Н.В. Фетальная хирургия: достижения и проблемы. Гинекология Эндокринология. 2017;13(142)–14(143):31–36.
Hoagland M.A., Chatterjee D. Anesthesia for fetal surgery. Paediatr Anaesth. 2017;27(4):346–357. DOI: 10.1111/pan.13109.
Gallagher K., Crombag N., Prashar K. et al. Global Policy and Practice for Intrauterine Fetal Resuscitation During Fetal Surgery for Open Spina Bifida Repair. JAMA Netw Open. 2023; 6(4):e239855. DOI: 10.1001/jamanetworkopen.2023.9855.
