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This article discusses the use of ultrasound in predicting perinatal morbidity in fetal sacrococcygeal teratoma (SCT), the most common tumor in neonates. The study aimed to develop a model for predicting perinatal outcomes in SCT using parameters obtained from mid-trimester ultrasound examinations. The study found that several sonographic characteristics, such as tumor volume, tumor volume-to-fetal weight ratio, and the presence of hydrops fetalis and hepatomegaly, were significantly associated with perinatal death in SCT cases. Abnormal ductus venosus waveforms and fetal hepatomegaly were identified as independent predictors of perinatal death. The findings suggest that incorporating the assessment of these characteristics into perinatal SCT work-up may help guide protocols for antenatal intervention and improve outcomes. [Extracted from the article]

Background: General anesthesia during pregnancy is not uncommon, for example, for trauma surgery, cerclage, or cesarean delivery. Current recommendations are to maintain maternal partial pressure of carbon dioxide in arterial blood (paCO2) at 30 mm Hg, which is based solely on the average maternal paCO2 in awake pregnant women. However, there is no evidence that this target, compared to other targets, would enable optimal conditions for the fetus during general anesthesia. Maternal paCO2 can affect uterine blood flow, affinity of hemoglobin for oxygen, and fetal CO2 elimination. In this study, a range of potential targets of maternal paCO2 was investigated in the ovine model, aiming to determine which target is most conducive to physiological fetal blood gas values during laparotomy with general anesthesia., Methods: Ten time-mated pregnant Swifter ewes with a gestational age of 93 to 104 days were used. During the first phase of the experiment, anesthesia was induced, all ewes were ventilated to target a physiological maternal paCO2 of 30 mm Hg, a maternal laparotomy was performed, and a fetal microcatheter was inserted surgically to enable blood sampling from the fetal aorta. Thereafter, in the second phase of the experiment, the 10 pregnant ewes were randomized to 10 different targets of maternal paCO2 between 27 and 50 mm Hg (1 target for each ewe), and maternal ventilation was adjusted accordingly. Forty-five minutes later, maternal and fetal arterial blood gas samples were analyzed. Linear regression models were used to estimate maternal paCO2 enabling physiologic fetal parameters, including fetal paCO2 (primary outcome)., Results: A maternal paCO2 of 27.4 mm Hg (95% confidence interval, 23.1-30.3) enabled physiological fetal paCO2. Each increase in maternal paCO2 by 1 mm Hg, on average, increased fetal paCO2 by 0.94 mm Hg (0.69-1.19). This relationship had a strong correlation (r² = 0.906). No fetuses died during the experiment., Conclusions: This study provides experimental support for the clinical recommendation to maintain maternal paCO2 close to the physiologic value of 30 mm Hg during general anesthesia for maternal laparotomy in pregnancy as it is conducive to physiological fetal blood gas values. Given the lower bound of the 95% confidence interval, the possibility that a lower maternal paCO2 would improve fetal gas exchange cannot be excluded., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2025 International Anesthesia Research Society.)

The aim of this pragmatic approach to retrospective observational study was to identify the end-tidal concentration of sevoflurane which was associated with optimal surgical conditions (i.e., absence of any movement, coughing and straining) in 127 pregnant sheep. Optimal surgical conditions were observed in 90% of the ewes with an end-tidal concentration of sevoflurane of 2.4 Vol-% [95% CI: 2.2; 2.8] during minimal-mild nociceptive stimuli (placement of arterial catheter, bladder catheter, shaving), with 4.4 Vol-% [95% CI: 4.0; 5.2] during maternal laparotomy and hysterotomy and with 4.4 Vol-% [95% CI: 3.9; 5.8] during subsequent manipulation of the uterus and fetal surgery.

Objective: This study reports the infant to preschool outcomes of a laparotomy-assisted, two-port fetoscopic myelomeningocele (MMC) repair and compares the results with those of a contemporary, same-center cohort that underwent either fetal MMC surgery via hysterotomy or postnatal MMC repair., Methods: All MMC closures between December 2011 and July 2021 were screened. Singleton pregnancies with hindbrain herniation and MMC between T1 and S1 were included. Fetuses were excluded for genetic abnormalities, severe kyphosis, and other congenital anomalies. The pregnant woman determined the method of MMC repair (fetoscopic, hysterotomy, or postnatal repair)., Results: Two hundred MMC closures met the study criteria (100 fetoscopic, 41 hysterotomy, and 59 postnatal). The median length of follow-up was beyond 46 months for all groups. The median gestational age at delivery was 38.1 weeks (IQR 35.1, 39.1 weeks) for the fetoscopic group, 35.7 weeks (IQR 33.6, 37.0 weeks) for the hysterotomy group, and 38.6 weeks (IQR 37.7, 39.0 weeks) for the postnatal group. Vaginal delivery occurred in 51% of the fetoscopic cases, and there were no instances of uterine dehiscence or rupture. Treatment for hydrocephalus in the 1st year occurred in 35% (95% CI 27%-50%) of fetoscopic, 33% (95% CI 20%-50%) of hysterotomy, and 81% (95% CI 70%-90%) of postnatal repair cases. At 30 months, patients who underwent fetal intervention were twice as likely to be community ambulators (with or without devices) as those who underwent postnatal repair (52% [95% CI 42%-62%] of fetoscopic, 54% [95% CI 39%-68%] of hysterotomy, and 24% [95% CI 14%-36%] of postnatal cases). Surgery for symptomatic tethered cord occurred in 12% (95% CI 7%-19%) of fetoscopic, 17% (95% CI 8%-31%) of hysterotomy, and 2% (95% CI 1%-8%) of postnatal repair cases. Surgery for symptomatic spinal inclusion cysts was required in 4% (95% CI 1%-9%) of fetoscopic, 7% (95% CI 2%-18%) of hysterotomy, and none (95% CI 0%-8%) of the postnatal cases., Conclusions: Laparotomy-assisted, two-port fetoscopic repair provides significant benefits for maternal health. It negates the risk of uterine rupture for the index pregnancy and subsequent pregnancies and allows for vaginal delivery. The benefits to the fetus are the same as those of hysterotomy repairs, with a lower risk of prematurity. There was no difference in the rate of surgery for tethered cord or spinal inclusion cysts between fetoscopic and hysterotomy procedures. Overall, laparotomy-assisted, two-port fetoscopic repair is safer for the fetus and the mother than fetal MMC surgery via hysterotomy.

Objective: To evaluate medium-term self-reported respiratory and gastrointestinal (GI) outcomes in children with congenital diaphragmatic hernia (CDH)., Design: Self-reported respiratory and GI outcomes correlated with prenatal severity indicators., Setting: Prospective study at three fetal medicine units., Population: Families of children prenatally diagnosed with isolated, left-sided CDH surviving for >1 year., Methods: Families received validated questionnaires for GI outcomes (Infant Gastroesophageal Reflux Questionnaire Revised, I-GERQ-R, for infants aged <2 years, or Paediatric Gastro-oesophageal Symptom and Quality of Life Questionnaire, PGSQ, for children aged aged 2-8 years or >9 years) and respiratory outcomes (preschool respiratory outcome questionnaire, for children aged ≤5 years, or the International Study of Asthma and Allergies in Childhood asthma questionnaire, for children aged 6-8 years or ≥9 years). Prenatal data collected from the medical records included lung size (percentage observed/expected lung-to-head ratio, O/E LHR %), liver position, fetal endoluminal tracheal occlusion (FETO) gestational age (GA) at delivery, and perinatal data included birthweight, location, patch repair and respiratory support., Main Outcome Measures: The GI and respiratory scores were correlated with O/E LHR using linear and logistic regression models. Univariate analysis was used to evaluate associations with perinatal variables., Results: We obtained 142 responses from 342 families (representing a response rate of 45%). The baseline characteristics of participants and non-participants were comparable. No correlations between perinatal variables and respiratory or GI scores were identified. Children aged ≤5 years with lower O/E LHR values reported higher respiratory scores (P = 0.0175); this finding was not reported in older children. Overall, the children who underwent FETO (n = 51) had GI (P = 0.290) and respiratory (P = 0.052) scores that were comparable with those of children who were expectantly managed., Conclusions: Families and children with prenatally diagnosed CDH reported fewer respiratory symptoms with increasing age. There was no correlation between O/E LHR or the use of FETO and self-reported outcomes., (© 2024 John Wiley & Sons Ltd.)

We systematically reviewed experiments in the fetal lamb model of gastroschisis using PubMed, Embase, Web of Science, and Scopus, seeking for standardized surgical techniques to obtain complex gastroschisis. Eligible were studies where an abdominal wall defect was surgically induced and gross anatomical findings at birth were available. The primary outcome was complex gastroschisis, defined by the presence of bowel stenosis, atresia, volvulus, perforation, and/or necrosis. Secondary outcomes were fetal death and additional readouts reported. Of ten eligible studies, six included lambs that had no additional prenatal manipulations and were assessed at term (35 lambs). Gastroschisis was induced at day 70-80 (term = 140-145), typically (n = 4/6 studies) in the left lower abdomen with defect size ranging from 0.5 to 4.0 cm. Only one study, in which a 1.5 cm diameter silicone ring was utilized, resulted in complex gastroschisis in 100% of term survivors. Fetal loss was more frequent in studies where a silicone ring and/or a right-sided defect were used. No changes unique to complex gastroschisis were identified in additional readouts, including bowel histology. When gastroschisis becomes "complex" following induction is uncertain. This knowledge is essential in studying potential prenatal interventions that may change the natural course., (© 2024 John Wiley & Sons Ltd.)