Laser coagulation of placental anastomoses with a 30° fetoscope in severe mid-trimester twin–twin transfusion syndrome with anterior placenta (original) (raw)
Related papers
Ultrasound in Obstetrics & Gynecology, 2007
Objective To assess outcome after fetoscopic laser coagulation (FLC) of placental vascular anastomoses with the 30 • fetoscope in mid-trimester severe twinto-twin transfusion syndrome (TTTS) with completely anterior placenta compared with the regular 0 • fetoscope in TTTS with other placental locations. Methods This was a prospective study of 176 consecutive monochorionic twin pregnancies undergoing FLC for severe TTTS. Of these, 51 patients required use of the 30 • fetoscope (study group) and 125 placental locations permitted use of the 0 • fetoscope (controls). Results The two groups had very similar outcomes. The median gestational age at FLC in the study group vs. control group was 21.0 (range, 17.4-24.6) weeks vs. 20.6 (range, 15.9-24.6) weeks. Both fetuses survived in 58.8% (30/51) of study patients vs. 66.4% (83/125) of controls. At least one fetus survived in 84.3% (43/51) of study patients and 88.8% (111/125) of controls (P = 0.45). Study patients delivered at a median of 34.1 (range, 25.0-38.4) weeks and controls at 34.0 (range, 25.0-40.3
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2013
To document perinatal outcomes following use of the 'Solomon technique' in the selective photocoagulation of placental anastomoses for severe twin-twin transfusion syndrome (TTTS). Between January 2010 and July 2012, data were collected from 102 consecutive monochorionic twin pregnancies complicated by severe TTTS that underwent fetoscopic laser ablation at four different centers. We compared outcomes between subjects that underwent selective laser coagulation using the Solomon technique (cases) and those that underwent selective laser coagulation without this procedure (controls). Of the 102 pregnancies examined, 26 (25.5%) underwent the Solomon technique and 76 (74.5%) did not. Of the 204 fetuses, 139 (68.1%) survived up to 30 days of age. At least one twin survived in 82 (80.4%) pregnancies and both twins survived in 57 (55.9%) pregnancies. When compared with the control group, the Solomon-technique group had a significantly higher survival rate for both twins (84.6 vs 46...
Ultrasound in Obstetrics & Gynecology, 2006
ObjectiveTo assess the feasibility and outcome of fetoscopic laser coagulation in pregnancies with twin reversed arterial perfusion (TRAP) sequence.To assess the feasibility and outcome of fetoscopic laser coagulation in pregnancies with twin reversed arterial perfusion (TRAP) sequence.MethodsIn a prospective multicenter study, percutaneous fetoscopic laser coagulation of placental anastomoses (n = 18) or the umbilical cord of the acardiac twin (n = 42) was performed in 60 consecutive pregnancies at a median gestational age of 18.3 (range, 14.3–24.7) weeks under local or locoregional anesthesia.In a prospective multicenter study, percutaneous fetoscopic laser coagulation of placental anastomoses (n = 18) or the umbilical cord of the acardiac twin (n = 42) was performed in 60 consecutive pregnancies at a median gestational age of 18.3 (range, 14.3–24.7) weeks under local or locoregional anesthesia.ResultsVascular coagulation with arrest of blood flow was achieved in 82% (49/60) of cases by laser alone and in a further 15% (9/60) by laser coagulation in combination with bipolar forceps. The overall survival rate of the pump twin was 80% (48/60). Median gestational age at delivery was 37.4 (range, 23.7–41.4) weeks and the median interval between the procedure and delivery was 18.2 (range, 1.1–25.7) weeks. Median birth weight was 2720 (range, 540–3840) g. Preterm premature rupture of membranes before 34 weeks' gestation occurred in 18% (11/60) at a median of 62 (range, 1–102) days after the procedure. However, only two (3%) women delivered within 28 days of the procedure.Vascular coagulation with arrest of blood flow was achieved in 82% (49/60) of cases by laser alone and in a further 15% (9/60) by laser coagulation in combination with bipolar forceps. The overall survival rate of the pump twin was 80% (48/60). Median gestational age at delivery was 37.4 (range, 23.7–41.4) weeks and the median interval between the procedure and delivery was 18.2 (range, 1.1–25.7) weeks. Median birth weight was 2720 (range, 540–3840) g. Preterm premature rupture of membranes before 34 weeks' gestation occurred in 18% (11/60) at a median of 62 (range, 1–102) days after the procedure. However, only two (3%) women delivered within 28 days of the procedure.ConclusionsFetoscopic laser coagulation of placental vascular anastomoses or the umbilical cord of the acardiac twin is an effective treatment of TRAP sequence, with a survival rate of 80%, and 67% of pregnancies with surviving pump twins going beyond 36 weeks' gestation without further complications. Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.Fetoscopic laser coagulation of placental vascular anastomoses or the umbilical cord of the acardiac twin is an effective treatment of TRAP sequence, with a survival rate of 80%, and 67% of pregnancies with surviving pump twins going beyond 36 weeks' gestation without further complications. Copyright © 2006 ISUOG. Published by John Wiley & Sons, Ltd.