IN-UTERO SURFACTANT ADMINISTRATION TO PRETERM HUMAN FETUSES USING ENDOSCOPY

Our purpose was to assess the feasibility of the endoscopic delivery o f surfactant directly to the fetus during active preterm labor. A gas- sterilized intraoperative fiberscope was introduced through the cervic al canal into the amniotic cavity after spontaneous rupture of membran es during preterm labor in 3 patients. The flexible fiberscope was ins erted under constant endoscopic visual control to avoid possible traum a to the fetus and the mother. Surfactant was injected into the mouths of 3 preterms fetuses through a catheter placed through the biopsy ch annel of the fiberscope. Fetal heart rate tracings as well as neonatal and maternal outcome are reported for each case. In utero surfactant placement was successfull in each case. The fetal heart rate remained normal throughout the procedure. No maternal or neonatal complications /infections were detected. Our preliminary experience indicates that i n utero endoscopic delivery of surfactant to a preterm human fetus is feasible. The usefulness of intrapartum endoscopy in the prophylactic administration of surfactant directly to the fetus, prior to the first breath, has to be assessed in a prospective controlled study.