Fetoscopic laser photocoagulation: a medically reasonable treatment option in the management of types II and III vasa previa
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Abstract
Vasa previa is a condition where unprotected fetal vessels cross the cervix within the membranes, posing a considerable risk of fetal death or severe morbidity if the membranes rupture before or during delivery. There has not been a definitive in utero treatment for this condition. Patients are typically closely monitored and hospitalized in the early third trimester and scheduled for cesarean delivery before term. This approach poses considerable physical, social, psychological, and financial challenges for pregnant patients and their families. Furthermore, fetal vessel rupture may lead to severe hypoxic-ischemic injury and consequent neurodevelopmental impairment. Finally, babies delivered early due to vasa previa may face both the short- and long-term consequences of prematurity. Recently, fetoscopic laser photocoagulation using a single-port fetoscope has emerged as a potential therapeutic option for patients with types II and III vasa previa. This innovative approach aims to reduce hospital stays, increases the chance of successful vaginal delivery, and potentially allows pregnancies to reach full term, providing lifelong benefits for the infant. Preliminary clinical studies on human subjects have demonstrated promising results concerning the feasibility, safety, and efficacy of this intervention for a subset of patients with types II and III vasa previa. After reviewing the current state of the art, we argued that offering fetoscopic laser photocoagulation in specialized centers under IRB supervision meets the ethical obligations of beneficence and non-maleficence for both pregnant and fetal patients, as well as the autonomy-based obligations for pregnant patients.
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Research ethics: Not applicable.
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Informed consent: Not applicable.
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Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission. We certify that all authors adhered fully to the authorship guidelines and contributed to all the following domains: 1. Substantial contributions to the conception and design of the work. 2. Drafting the work and revising it critically for important intellectual content. Several virtual discussions occurred among all co-authors regarding the ethical aspects of this procedure in vasa previa. 3. Final approval of the manuscript and scientific validity of the illustration (Figure 1). 4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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Competing interests: The authors state no conflict of interest.
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Research funding: None declared.
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Data availability: Not applicable.
References
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© 2024 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Review
- The utilization of artificial intelligence in enhancing 3D/4D ultrasound analysis of fetal facial profiles
- Commentary
- Respect for history: an important dimension of contemporary obstetrics and gynecology
- Opinion Papers
- Fetoscopic laser photocoagulation: a medically reasonable treatment option in the management of types II and III vasa previa
- Efficacy and safety of 2-drug regime dolutegravir/lamivudine in pregnancy and breastfeeding – clinical implications and perspectives
- Original Articles – Obstetrics
- The potential impact of universal screening for vasa previa in the prevention of stillbirths
- Preinduction cervical ripening in an outpatient setting: a prospective pilot study of a synthetic osmotic dilator compared with a double-balloon catheter
- Transperineal sonographic assessment of the angle of progression before the onset of labour: how well does it predict the mode of delivery in late-term pregnancy
- Prediction of intrapartum caesarean section in vaginal breech birth: development of models for nulliparous and multiparous women
- Complementary and Alternative Medicine use among pregnant women attending antenatal clinic: a point to ponder
- Molecular evidence that GBS early neonatal sepsis results from ascending infection: comparative hybrid genomics analyses show that microorganisms in the vaginal ecosystem, amniotic fluid, chorioamniotic membranes, and neonatal blood are the same
- Original Articles – Fetus
- Echocardiographic markers at diagnosis of persistent pulmonary hypertension of the newborn
- New measurement indicator of ultrasound assessment of the fetal pancreas based on anatomical landmarks and its application to fetuses with gestational diabetes mellitus
- Original Articles – Neonates
- Mode of delivery and behavioral and neuropsychological outcomes in children at 10 years of age
- Assessment of the validity and reliability of edinburgh postpartum depression scale in Turkish men
- Letter to the Editor
- Frequency and persistence of wide pulse pressure in the newborn population
Articles in the same Issue
- Frontmatter
- Review
- The utilization of artificial intelligence in enhancing 3D/4D ultrasound analysis of fetal facial profiles
- Commentary
- Respect for history: an important dimension of contemporary obstetrics and gynecology
- Opinion Papers
- Fetoscopic laser photocoagulation: a medically reasonable treatment option in the management of types II and III vasa previa
- Efficacy and safety of 2-drug regime dolutegravir/lamivudine in pregnancy and breastfeeding – clinical implications and perspectives
- Original Articles – Obstetrics
- The potential impact of universal screening for vasa previa in the prevention of stillbirths
- Preinduction cervical ripening in an outpatient setting: a prospective pilot study of a synthetic osmotic dilator compared with a double-balloon catheter
- Transperineal sonographic assessment of the angle of progression before the onset of labour: how well does it predict the mode of delivery in late-term pregnancy
- Prediction of intrapartum caesarean section in vaginal breech birth: development of models for nulliparous and multiparous women
- Complementary and Alternative Medicine use among pregnant women attending antenatal clinic: a point to ponder
- Molecular evidence that GBS early neonatal sepsis results from ascending infection: comparative hybrid genomics analyses show that microorganisms in the vaginal ecosystem, amniotic fluid, chorioamniotic membranes, and neonatal blood are the same
- Original Articles – Fetus
- Echocardiographic markers at diagnosis of persistent pulmonary hypertension of the newborn
- New measurement indicator of ultrasound assessment of the fetal pancreas based on anatomical landmarks and its application to fetuses with gestational diabetes mellitus
- Original Articles – Neonates
- Mode of delivery and behavioral and neuropsychological outcomes in children at 10 years of age
- Assessment of the validity and reliability of edinburgh postpartum depression scale in Turkish men
- Letter to the Editor
- Frequency and persistence of wide pulse pressure in the newborn population
