Intraamniotic Fetal Echocardiography

A 33-year-old pregnant women had been referred to our center at 28+1 weeks’ gestation. Maternal transabdominal fetal ultrasound imaging at that time revealed a fetal congenital diaphragmatic hernia with very hypoplastic lungs. Because of the poor prognosis of the fetal congenital diaphragmatic hernia, temporary fetoscopic balloon occlusion was performed as a potentially live-saving experimental treatment approach. Fetoscopic tracheal balloon removal was scheduled at 32+5 weeks’ gestation. At that time, fetal ultrasound imaging was more difficult because of the more advanced gestational age in combination with severe adipositas (body mass index = 43 kg/m2) and polyhydramnios (Figure 1). Therefore, the feasibility of intraamniotic fetal echocardiography (IFE) was assessed as a more suitable monitoring tool. The fetoscopic and ultrasound-guided procedure was performed with parental informed consent and approval from the local committee of human research, in accordance with the ethical standards for human experimentation established by the Declaration of Helsinki. Figure 1. Preoperative magnetic resonance image (top) at 32+4 weeks’ gestation demonstrating the obstacles adipositas and polyhydramnios for conventional maternal transabdominal fetal echocardiography in this patient (arrow points at latex balloon inside the fetal trachea). At that time, maternal transabdominal imaging was even more difficult than at initial presentation because of the more advanced gestational age in combination with severe adipositas (body mass index = 43 kg/m2) and polyhydramnios. Two-dimensional cross-section images (middle …