Transabdominal needle embryofetoscopy: A new technique paving the way for early fetal therapy

Objective: To explore the feasibility of using a newly devised needle endoscope to conduct transabdominal first-trimester endoscopy for both embryonic visualization and blood sampling. Methods: Following informed consent, 12 patients at 8-12 weeks’ gestation undergoing first-trimester termination were invited to participate in this study. Transabdominal needle embryofetoscopy was also performed in one continuing pregnancy. A specially designed 16-gauge, double-barrel instrument sheath equipped with 0.8-mm fiberoptic endoscope and a customized 27-gauge heparinized needle were passed transabdominally under ultrasound guidance through the uterine wall and into the exocoelomic space. Results: Using first-trimester transabdominal needle embryofetoscopy, we were able to identify the normal anatomical landmarks of the embryo and were also able to gain access to the embryonic circulation by advancing the 27-gauge needle into the umbilical vessels. In addition, we were able to infuse indigo carmine dye into the fetal circulation of three subjects. Needle embryofetoscopy was also used in a continuing pregnancy for prenatal diagnosis. Conclusion: Our experience establishes the feasibility of first-trimester transabdominal needle embryofetoscopy for embryonic visualization and access to the circulation. This new development is expected to serve as a basis for further studies attempting to diagnose and treat congenital diseases in early pregnancy.