. Author manuscript; available in PMC: 2023 Jun 1.

Published in final edited form as: Obstet Gynecol. 2022 May 2;139(6):1027–1042. doi: 10.1097/AOG.0000000000004793

Table 2.

Ultrasound guided shunting or fetoscopic fetal interventions

PROCEDURE	REPORTED PROCEDURAL RISKS	REQUIRED RESOURCES
Shunting procedures^103–110 Instrument diameter: 6–9 French (1.83–3 mm)	Maternal: Myometrial bleeding <1%	Maternal: L&D unit if viable; OB anesthesiology for iv conscious sedation or rarely neuraxial anesthesia
	Fetal: Shunt failure/dislodgement 8–35%; Chorio-amnion separation up to 7.7%; PPROM up to 10%; fetal death up to 12%	Fetal: Trained intervention team, medications for fetal administration as required.
	Neonatal: Premature delivery (<34 weeks up to 56%); NICU admission up to 83%; neonatal death up to 22%	Neonatal: NICU if viable with sub-specialty access as dictated by the fetal disease per se.
Bipolar or fetoscopic cord coagulation^{76, 95, 96, 97} Instrument diameter: 1.5–5 mm	Maternal: Trocar site bleeding 1–3%	Maternal: Dedicated intervention setting, L&D unit; OB anesthesiology for IV conscious sedation or neuraxial anesthesia as required
	Fetal: Co-twin demise 8–14%; PPROM < 32 wks 23–34%; Chorio-amnion separation 5–10%	Fetal: Trained intervention team with specific procedural expertise at the expected level of complexity
	Neonatal: Premature delivery (< 32 weeks 23–34%); neonatal death 6–12%	Neonatal: NICU if viable with subspecialty access if more severe fetal disease is present
Fetoscopic laser surgery^{18,22, 76, 74, 134, 132} Instrument diameter: 5–12 French (1.5–4 mm)	Maternal: pulmonary edema 1–8%; ICU admission 1–2%; trocar site bleeding 5–7%; maternal blood transfusion up to 2.9%; intra-abdominal fluid leakage 1–7%	Maternal: Dedicated intervention setting, L&D unit, OB anesthesiology for IV conscious sedation or neuraxial anesthesia as required, Blood bank, ICU availability
	Fetal: PPROM <24 hrs. 3–4%; Chorioamnion separation 5–10%; placental abruption 1–3%; PPROM < 32 wks 19–34%;	Fetal: Trained intervention team with specific procedural expertise at the expected level of complexity
	Neonatal: Preterm birth < 33 weeks up to 36%	Neonatal: NICU if viable, access to pediatric cardiology access with severe fetal disease
Fetoscopic endotracheal occlusion (FETO)^{76, 114, 120, 121, 132} Instrument diameter: 10 French (3.3 mm)	Maternal: abdominal hemorrhage 0.5%	Maternal: Dedicated intervention setting, L&D unit, OB anesthesiology for iv. conscious sedation or neuraxial anesthesia as required, Blood bank, ICU availability
	Fetal: fetal death: 2%; unscheduled balloon removal up to 56%, unscheduled EXIT up to 7%	Fetal: Expertise with FETO procedure, On-call multidisciplinary team for emergent balloon removal or EXIT.
	Neonatal: PTB < 34 weeks up to 31%; postnatal balloon removal up to 17%	Neonatal: NICU, PICU, Pediatric Surgery, Pediatric anesthesiology, Pediatric cardiology, ECMO, Pediatric ENT
Percutaneous fetoscopic MMC closure^{116–119, 130} Instrument diameter 10–15 French (3.3–5 mm), up to 4 ports.	Maternal: Pulmonary edema 2%; abdominal CO₂ leak 20–33%	Maternal: Dedicated intervention setting, L&D unit, OB anesthesiology for iv. conscious sedation, neuraxial or general anesthesia as required, Blood bank, Adult ICU
	Fetal: PPROM < 34 wks: 67%	Fetal: Fetal MFM surgeon, pediatric neurosurgery
	Neonatal: PTB < 35 weeks up to 23%; CSF leakage at birth up to 32%	Neonatal: NICU with subspecialty care, pediatric neurosurgery, pediatric anesthesiology

Legend:, MFM= Maternal-Fetal Medicine, OB Anesthesiology = Obstetric Anesthesiology, NICU = neonatal intensive care unit, PTB = preterm birth, L&D = Labor & Delivery, LUTO = lower urinary tract obstruction, PICU = pediatric intensive care unit, PPROM = preterm premature rupture of membranes, EXIT = ex-utero intrapartum treatment, ECMO = extracorporeal membrane oxygenation.