Abstract：
To compare the occurrence of fetal bradycardia in open versus fetoscopic fetal spina bifida surgery.
This is a single-institution retrospective cohort study of patients undergoing open (n = 25) or fetoscopic (n = 26) spina bifida repair between 2017 and 2022. From October 2017 to June 2020, spina bifida repairs were performed via an open classical hysterotomy, and from November 2020 to June 2022 fetoscopic repairs were performed following transition to this technique. Fetal heart rate (FHR) in beats per minute (bpm) was recorded via echocardiography every 15 min during the procedure. Cohort characteristics, fetal bradycardia and maternal physiologic parameters were compared between the groups.
Fetuses undergoing an open repair more frequently developed bradycardia defined as <110 bpm (32% vs. 3.8%, p = 0.008), and a trend was observed for FHR decreases more than 25 bpm from baseline (20% vs. 3.8%, p = 0.073). Profound bradycardia less than 80 bpm was rare, occurring in only three operations (two in open, one in fetoscopic repair) with two fetuses (one in each group) requiring emergency cesarean delivery.
When compared to open fetal surgery, fetal bradycardia occurred less frequently in fetoscopic surgery despite a significantly greater anesthetic exposure and the use of the intraamniotic carbon dioxide insufflation.
This is a single-institution retrospective cohort study of patients undergoing open (n = 25) or fetoscopic (n = 26) spina bifida repair between 2017 and 2022. From October 2017 to June 2020, spina bifida repairs were performed via an open classical hysterotomy, and from November 2020 to June 2022 fetoscopic repairs were performed following transition to this technique. Fetal heart rate (FHR) in beats per minute (bpm) was recorded via echocardiography every 15 min during the procedure. Cohort characteristics, fetal bradycardia and maternal physiologic parameters were compared between the groups.
Fetuses undergoing an open repair more frequently developed bradycardia defined as <110 bpm (32% vs. 3.8%, p = 0.008), and a trend was observed for FHR decreases more than 25 bpm from baseline (20% vs. 3.8%, p = 0.073). Profound bradycardia less than 80 bpm was rare, occurring in only three operations (two in open, one in fetoscopic repair) with two fetuses (one in each group) requiring emergency cesarean delivery.
When compared to open fetal surgery, fetal bradycardia occurred less frequently in fetoscopic surgery despite a significantly greater anesthetic exposure and the use of the intraamniotic carbon dioxide insufflation.
摘要：
目的：比较胎儿脊柱裂手术中胎儿心动过缓的发生情况。
方法：这是一项单机构回顾性队列研究，研究对象为2017年至2022年期间接受开放式（n=25）或胎儿镜（n=26）脊柱裂修复的患者。从2017年10月到2020年6月，脊柱裂通过开放的经典子宫切开术进行修复，从2020年11月至2022年6月，在过渡到该技术后进行了胎儿镜检修复。在手术过程中每15分钟通过超声心动图记录胎心率（FHR），以每分钟心跳（bpm）为单位。队列特征，两组比较了胎儿心动过缓和母体生理参数.
结果：接受开放式修复的胎儿更频繁地发生心动过缓，定义为<110bpm（32％vs.3.8%,p=0.008),并且观察到FHR从基线下降超过25bpm的趋势(20%与3.8%,p=0.073)。心动过缓低于80bpm是罕见的，只发生在三个操作中(两个在开放中，胎儿镜修复1例），有两个胎儿（每组1例）需要紧急剖宫产。
结论：与开腹胎儿手术相比，胎儿心动过缓在胎儿镜手术中发生的频率较低,尽管显著增加了麻醉暴露量和使用羊膜腔内二氧化碳吹气.
方法：这是一项单机构回顾性队列研究，研究对象为2017年至2022年期间接受开放式（n=25）或胎儿镜（n=26）脊柱裂修复的患者。从2017年10月到2020年6月，脊柱裂通过开放的经典子宫切开术进行修复，从2020年11月至2022年6月，在过渡到该技术后进行了胎儿镜检修复。在手术过程中每15分钟通过超声心动图记录胎心率（FHR），以每分钟心跳（bpm）为单位。队列特征，两组比较了胎儿心动过缓和母体生理参数.
结果：接受开放式修复的胎儿更频繁地发生心动过缓，定义为<110bpm（32％vs.3.8%,p=0.008),并且观察到FHR从基线下降超过25bpm的趋势(20%与3.8%,p=0.073)。心动过缓低于80bpm是罕见的，只发生在三个操作中(两个在开放中，胎儿镜修复1例），有两个胎儿（每组1例）需要紧急剖宫产。
结论：与开腹胎儿手术相比，胎儿心动过缓在胎儿镜手术中发生的频率较低,尽管显著增加了麻醉暴露量和使用羊膜腔内二氧化碳吹气.
