| Alternative technique for Nd: YAG laser coagulation in twin-to-twin transfusion syndrome with anterior placenta. | |
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MedLine Citation:
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PMID: 9644775 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Nd: YAG laser coagulation is used to treat severe twin-to-twin transfusion syndrome (TTS). Success of the technique depends on visualization of the placenta, the fetal membranes and the targeted vessels, as well as obtaining an optimal inclination angle for laser coagulation. In the rare case of an extensive anterior placenta, it may be difficult to achieve these conditions using the percutaneous approach. Here, we propose an alternative to the percutaneous procedure. Modifications involve an open access and the use of a flexible cannula and bent scope. An extraplacental area, usually at the fundus, is identified by B-mode and color Doppler imaging. A mini-laparotomy is made under general anesthesia. The viscera are retracted and the cannula is inserted under direct view and ultrasound control by the Seldinger technique. The curved fiberscope is passed through the flexible cannula, allowing adequate inspection of the placenta, and target vessels can be coagulated at an angle close to 90 degrees. After the procedure, the uterus is closed primarily to prevent postoperative leakage of amniotic fluid or hemorrhage. This technique has been successfully used in six patients with TTS and a completely anterior placenta, with a gestational age between 18.5 and 22.0 weeks. In all patients, the amniotic cavity was accessed without hemorrhage. The outcomes are similar to those published previously for laser coagulation. The mean interval from intervention until delivery was 10.5 weeks. All 12 fetuses were live born but four died from complications of extreme prematurity. No maternal complications occurred. |
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Authors:
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J A Deprest; D Van Schoubroeck; P P Van Ballaer; H Flageole; F A Van Assche; K Vandenberghe |
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Publication Detail:
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Type: Clinical Trial; Journal Article |
Journal Detail:
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Title: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology Volume: 11 ISSN: 0960-7692 ISO Abbreviation: Ultrasound Obstet Gynecol Publication Date: 1998 May |
Date Detail:
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Created Date: 1998-09-08 Completed Date: 1998-09-08 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 9108340 Medline TA: Ultrasound Obstet Gynecol Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 347-52 Citation Subset: IM |
Affiliation:
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Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Leuven, Belgium. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Female Fetofetal Transfusion / diagnosis, surgery* Fetoscopy Fetus / surgery* Gestational Age Humans Laser Coagulation / instrumentation, methods* Placenta / abnormalities*, surgery Pregnancy Pregnancy Outcome* Pregnancy, Multiple Syndrome Treatment Outcome |
| Comments/Corrections | |
Comment In:
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Ultrasound Obstet Gynecol. 1999 Apr;13(4):285-6
[PMID:
10341413
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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