The use of fetoscopy was first developed in the 1990s. The process involves ultrasound-guided placement of a stethoscope – a small, fiber optic instrument – in the uterus to see the fetus and the placenta.
Fetoscopy as a surgical procedure can treat various fetal conditions including congenital diaphragmatic hernia and bladder outlet obstruction. Its most common use is the treatment of a rare condition, Twin-Twin Transfusion Syndrome (TTTS).
The condition of TTTS occurs when identical twins share a placenta with blood vessel connections that cause blood to flow unevenly between the two fetuses. According to the article, “Caught on Camera” by attorney Jeffrey B. Killino, one of the fetuses develops a small amniotic sac while the other sac becomes too large. Laser fetoscopy allows the laser to break up and collapse these blood vessel connections. Reportedly, if the condition is not treated, both of the fetuses can die. TTTS occurs in approximately 1 in 2,500 pregnancies. It is expected that there will be a rise in TTTS occurrences because of the increase in fertility-assisted pregnancies.
The danger of the laser fetoscopy surgery is that it too often can cause some very serious injuries to the unborn. For example, there are reports of deviations from the standard of care and the use of fetoscopy surgery that have caused cerebral palsy and brain damage to the unborn. These conditions, caused by medical negligence, are not manifested until after the birth of the child or children.
The errors of laser fetoscopy is most common when the targeted area is missed or the targeted area hits and damages another organ. Video of the surgery is generally available and is naturally the best evidence of what occurred. Laser targets can disrupt the function of healthy tissues of the placenta and the blood vessels needed to nourish and oxygenate the fetus.
It has been said that fetoscopy medical negligence cases are different from other birth injury lawsuits because the patients and families are not aware of the possible malpractice. Most of the cases where laser fetoscopy is in use are those pregnancies that are considered high risk. With that condition overlying the pregnancy, neurological injuries and fetal death caused by fetoscopy surgery are often attributable to the high risk of the pregnancy and not connected initially to negligence by the medical providers.
Fetoscopy injury cases may include other complications such as infection, prematurity and other damages that need to be sorted out with the plaintiff’s counsel’s experts.
As is in the case in most medical malpractice cases, the defendants are quick to defend physician negligence, hospital negligence, and nursing negligence based on the neurological impairment of the newborn or fetal death in high-risk pregnancies. It cannot be overlooked that data shows that a relatively low risk of neurological impairment occurs when fetascopic laser surgery is done correctly.
One study of TTTS outcomes lists the incidence of severe neurological impairment at only 4 out of 100, which is about the same as identical twins sharing the same placenta. Defendants typically use data as a means of defense. In other words, this almost never happens.
It may even be possible in some of the fetoscope negligence lawsuits that the malpractice is visible on the video, which would be important to show to the jurors at trial. However, the vision is so small, only several millimeters wide, that it is imperative that medical experts are available to testify from perhaps a demonstrative, anatomical rendering of the surgical field in order for the jury to fully grasp the negligence featured in the video.
It also should be noted that the laser beams do not emit visible energy and therefore thermal damage from the heat of a misfired laser beam is not so apparent. It has been suggested by the author of this article, Jeffrey B. Killino, that photographs of microscopic images of the damaged tissue be prepared for a pathologist or other expert to present to the jurors and to testify about how the damage to tissues occurred because of the negligence of the physicians.
Rubén A. Quintero & Walter Morales, Operative Fetoscopy: A New Frontier in Fetal Medicine, 44 contemporary obstetrics/gynecology 45 (1999). Much of the information gleaned from this post comes from the well-written and well-researched article in Trial Magazine, November 2018, by attorney Jeffrey B. Killino.
Kreisman Law Offices has been handling birth trauma injury lawsuits, cerebral palsy lawsuits and brain damage injury lawsuits for individuals, families and loved ones who have been harmed, injured or died as a result of the carelessness or negligence of a medical provider for more than 40 years in and around Chicago, Cook County and its surrounding areas, including LaGrange Park, Hillside, Berkeley, Northlake, Franklin Park, Frankfort, Rolling Meadows, Hoffman Estates, Glencoe, Highland Park, Chicago (Kenwood, Irving Park, Noble Square, North Ravenswood, Pullman, Ravenswood, Irving Park East, Dearborn Park, Douglas, East Rogers Park, Fulton River District, River North, Gold Coast, Albany Park), Cicero, Palos Heights, Palatine, Markham, Lyons, Lynwood, Justice, Roselle, Summit, South Barrington, South Holland, Streamwood, Elmwood Park, Brookfield, Buffalo Grove and Orland Hills, Ill.
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