{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T08:45:29Z","timestamp":1790153129994,"version":"4.0.1"},"reference-count":41,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,8,2]],"date-time":"2024-08-02T00:00:00Z","timestamp":1722556800000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      Fetoscopic closure of spina bifida using heated and humidified carbon dioxide gas (hhCO\n                      <jats:sub>2<\/jats:sub>\n                      ) has been associated with lower maternal morbidity compared with open closure. Fetal cardiovascular changes during these surgical interventions are poorly defined. Our objective was to compare fetal bradycardia (defined as fetal heart rate (FHR) &lt;\u2009110\u2009bpm for 10\u2009min) and changes in umbilical artery (UA) Doppler parameters during open\n                      <jats:italic>vs<\/jats:italic>\n                      fetoscopic closure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was a prospective cohort study of 22 open and 46 fetoscopic consecutive\n                      <jats:italic>in\u2010utero<\/jats:italic>\n                      closures conducted between 2019 and 2023. Both cohorts had similar preoperative counseling and clinical management. FHR and UA Doppler velocimetry were obtained systematically during preoperative assessment, every 5\u2009min during the intraoperative period, and during the postoperative assessment. FHR, UA pulsatility index (PI) and UA end\u2010diastolic flow (EDF) were segmented into hourly periods during surgery, and the lowest values were averaged for analysis. Umbilical vein maximum velocity was measured in the fetoscopic cohort. At each timepoint at which FHR was recorded, maternal heart rate and systolic and diastolic blood pressure were measured.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fetal bradycardia occurred in 4\/22 (18.2%) cases of open closure and 21\/46 (45.7%) cases of fetoscopic closure (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.03). FHR decreased gradually in both cohorts after administration of general anesthesia and decreased further during surgery. FHR was significantly lower during hour 2 of surgery in the fetoscopic\u2010repair cohort compared with the open\u2010repair cohort. The change in FHR from baseline in the final stage of fetal surgery was significantly more pronounced in the fetoscopic\u2010repair cohort compared with the open\u2010repair cohort (mean, \u221232.4 (95%\u2009CI, \u221235.7 to \u221229.1) bpm\n                      <jats:italic>vs<\/jats:italic>\n                      \u221223.5 (95%\u2009CI, \u221228.1 to \u221218.8)\u2009bpm;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.002). Abnormal UA\u2010EDF (defined as absent or reversed EDF) occurred in 3\/22 (13.6%) cases in the open\u2010repair cohort and 23\/46 (50.0%) cases in the fetoscopic\u2010repair cohort (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.004). There were no differences in UA\u2010EDF or UA\u2010PI between closure techniques at the individual stages of assessment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      We observed a decrease in FHR and abnormalities in UA Doppler parameters during both open and fetoscopic spina bifida closure. Fetal bradycardia was more prominent during fetoscopic closure following hhCO\n                      <jats:sub>2<\/jats:sub>\n                      insufflation, but FHR recovered after cessation of hhCO\n                      <jats:sub>2<\/jats:sub>\n                      . Changes in FHR and UA Doppler parameters during\n                      <jats:italic>in\u2010utero<\/jats:italic>\n                      spina bifida closure were transient, no cases required emergency delivery and no fetoscopic closure was converted to open closure. These observations should inform algorithms for the perioperative management of fetal bradycardia associated with\n                      <jats:italic>in\u2010utero<\/jats:italic>\n                      spina bifida closure. \u00a9 2024 International Society of Ultrasound in Obstetrics and Gynecology.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.27579","type":"journal-article","created":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T14:53:11Z","timestamp":1704984791000},"page":"193-202","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Fetal cardiovascular changes during open and fetoscopic\n                    <i>in\u2010utero<\/i>\n                    spina bifida closure"],"prefix":"10.1002","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0963-1584","authenticated-orcid":false,"given":"S.","family":"Backley","sequence":"first","affiliation":[{"name":"Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School University of Texas Health Science Center at Houston  Houston TX USA"},{"name":"The Fetal Center at Children's Memorial Hermann Hospital  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6276-854X","authenticated-orcid":false,"given":"E. P.","family":"Bergh","sequence":"additional","affiliation":[{"name":"Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School University of Texas Health Science Center at Houston  Houston TX USA"},{"name":"The Fetal Center at Children's Memorial Hermann Hospital  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Garnett","sequence":"additional","affiliation":[{"name":"Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School University of Texas Health Science Center at Houston  Houston TX USA"},{"name":"The Fetal Center at Children's Memorial Hermann Hospital  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science UTHealth School of Public Health  Houston TX 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