Reece E A, Homko C, Goldstein I, Wiznitzer A
Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Haifa, Israel.
Ultrasound Obstet Gynecol. 1995 Apr;5(4):281-5. doi: 10.1046/j.1469-0705.1995.05040281.x.
Our objective was to explore the feasibility of using both transvaginal endoscopy and transabdominal needle embryofetoscopy for early prenatal diagnosis. Our experience with both terminating and continuing pregnancies is presented in this report. Following the granting of informed consent, patients undergoing first-trimester terminations were invited to participate in this program. Initially, a transvaginal endoscope was used in these studies: a rigid fiberoptic endoscope 30 cm in length with a diameter of 1.5 mm. Subsequently, a specially designed 16-gauge, double-barrel needle sheath, equipped with a 0.8-mm fiberoptic endoscope and a customized 27-gauge heparinized needle were used. In either case, the endoscope was passed under ultrasound guidance into the exocelomic space, from which the anatomy of the embryo/fetus was scrutinized. For continuing pregnancies, patients were selected when at high risk for various dysmorphology syndromes. To date, we have successfully performed more than 300 transvaginal procedures, successfully visualized the fetus in 95% of cases, and verified sonographically suspected anomalies in all of the five cases studied. We have also performed 20 transabdominal procedures, 15 in terminating pregnancies and five in continuing pregnancies, without adverse effects. Our experience establishes the feasibility of first-trimester diagnostic endoscopy. This new development is expected to serve as a prelude for further studies that attempt to diagnose and treat congenital diseases in early pregnancy. Potential applications include gene and stem-cell therapy at a time when the embryo is immunologically naive.
我们的目标是探索经阴道内镜检查和经腹针式胚胎胎儿镜检查用于早期产前诊断的可行性。本报告介绍了我们在终止妊娠和继续妊娠方面的经验。在获得知情同意后，邀请接受孕早期终止妊娠的患者参与本项目。最初，在这些研究中使用了经阴道内镜：一种长度为30厘米、直径为1.5毫米的硬质纤维内镜。随后，使用了一种专门设计的16号双腔针鞘，配备有0.8毫米的纤维内镜和定制的27号肝素化针。在任何一种情况下，内镜都在超声引导下进入胚外体腔，从这里仔细检查胚胎/胎儿的解剖结构。对于继续妊娠的情况，当患者有各种畸形综合征的高风险时被选中。迄今为止，我们已成功进行了300多次经阴道操作，95%的病例成功观察到胎儿，并在所有研究的5例病例中通过超声证实了疑似异常。我们还进行了20次经腹操作，其中15次用于终止妊娠，5次用于继续妊娠，均无不良反应。我们的经验证实了孕早期诊断性内镜检查的可行性。这一新进展有望成为进一步研究的前奏，这些研究试图在妊娠早期诊断和治疗先天性疾病。潜在的应用包括在胚胎免疫幼稚期进行基因和干细胞治疗。
