School of Clinical Sciences at Monash Health (SCS) student Ms Sasha Skinner is the highest achieving BMedSc(Hons) student in the entire 2016 cohort.
Supervised by Dr Ryan Hodges, The Ritchie Centre, Hudson Institute of Medical Research and the Department of Obstetrics and Gynaecology, Monash University, Sasha’s project investigated experimental intra-amniotic carbon dioxide insufflation for fetal surgery to improve outcomes of babies with spina bifida.
“Prenatal repair of spina bifida improves neurological outcomes and prevents intracranial complications at birth,” said Sasha.
“To reduce significant maternal morbidity and high rates of preterm birth associated with open fetal surgery, fetoscopic spina bifida repair is proposed as a minimally invasive alternative.”
“Partial amniotic carbon dioxide insufflation (PACI) is one method to overcome the technical challenges of operating endoscopically in amniotic fluid.”
PACI involves partially draining amniotic fluid and insufflating the uterus with carbon dioxide—PACI increases space, improves visualisation and allows the use of surgical glues.
Sasha said that evidence of fetal safety during PACI is not well established and in sheep models, PACI causes fetal hypercapnia and acidosis.
“The effects of PACI on fetal-placental circulation or the developing fetal brain are unknown,” said Sasha.
“My project assessed the effect of PACI, at clinically used insufflation pressures, on the fetal-placental circulation, fetal and maternal acid base status and on the developing fetal brain in a sheep model.”
“We found PACI has detrimental implications for fetal physiology including large reductions in uterine blood flow, severe fetal hypercapnia, acidosis, hypoxia and lactic acidosis, increased fetal heart rate and blood pressure.”
Sasha’s study found that PACI leads to cerebrovascular changes on fetal brain histology and should not be performed in human fetuses until further studies have addressed these safety concerns in animal models.
Sasha said her BMedSc(Hons) year had sparked a passion and research will undoubtedly be something she remains involved in for many years to come.
“I have learnt so much, not just about science and the laboratory, but also an unexpectedly large amount about my personal ambitions and capabilities.”
“I have had a fantastic year and thoroughly enjoyed working with such passionate and dedicated people.”