Document Detail


Bipolar cord coagulation for selective feticide in complicated monochorionic twin pregnancies: 118 consecutive cases at a single center.
MedLine Citation:
PMID:  22173905     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES: To review the experience with selective feticide with bipolar cord coagulation (BCC) in complicated monochorionic (MC) twin pregnancies at a single center. METHODS: Retrospective analysis of BCC performed by 3-mm bipolar forceps under ultrasound control in cases complicated by twin-to-twin transfusion syndrome, selective growth restriction, discordant anomaly or twin reverse arterial perfusion sequence. RESULTS: The series comprised 118 cases with a median gestational age at time of procedure of 22 weeks (range 16-30). There were 14 intrauterine deaths of the co-twin (12%), 8 miscarriages (7%), and one termination of pregnancy (1%). When BCC was performed before 19 weeks, the rate of miscarriage was 45%, whereas it was 3% (p < 0.001) after 19 weeks. Preterm prelabor rupture of membranes (PPROM) occurred in 45 cases (38%). The median interval between BCC and PPROM was 5 weeks (interquartile range 2-8). In 15 cases (13%), PPROM occurred within two weeks after the procedure. Median gestational age at delivery was 34 weeks (range 24-41). The median birthweight was 2103 g (range 480-3875). Neonatal death occurred in 11 cases (9%), and 2 children (2%) had severe neurologic morbidity. The overall survival rate was 71% (84/118). CONCLUSION: BCC is an effective procedure in complicated MC twin pregnancies for a selective feticide or when one fetus is severely jeopardized and delivery is not yet an option. Better outcomes can be achieved when this procedure is performed after 19 weeks. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.
Authors:
Mariano M Lanna; Maria Angela Rustico; Marinella Dell'avanzo; Vito Schena; Stefano Faiola; Dario Consonni; Andrea Righini; Barbara Scelsa; Enrico M Ferrazzi
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-12-15
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  -     ISSN:  1469-0705     ISO Abbreviation:  -     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.
Affiliation:
Department of Obstetrics and Gynecology, Children's Hospital V. Buzzi, Milan, Italy. marianomatteo.lanna@fastwebnet.it.
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