Document Detail


Fetoscopic laser ablation of placental anastomoses in twin-twin transfusion syndrome using 'Solomon technique'.
MedLine Citation:
PMID:  23616360     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To document perinatal outcomes following use of the 'Solomon technique' in the selective photocoagulation of placental anastomoses for severe twin-twin transfusion syndrome (TTTS).
METHODS: 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).
RESULTS: 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 46.1%; P < 0.01) and a higher overall neonatal survival rate (45/52 (86.5%) vs 94/152 (61.8%); P < 0.01). Use of the Solomon technique remained independently associated with dual twin survival (adjusted odds ratio (aOR), 11.35 (95% CI, 3.11-53.14); P = 0.0007) and overall neonatal survival rate (aOR, 4.65 (95% CI, 1.59-13.62); P = 0.005) on multivariable analysis. There were no cases of recurrent TTTS or twin anemia-polycythemia sequence (TAPS) in the Solomon-technique group.
CONCLUSIONS: Use of the Solomon technique following selective laser coagulation of placental anastomoses appears to improve twin survival and may reduce the risk of recurrent TTTS and TAPS. Our data support the idea of performing a randomized controlled trial to evaluate the effectiveness of the Solomon technique.
Authors:
R Ruano; C Rodo; J L Peiro; A A Shamshirsaz; S Haeri; M L Nomura; E M A Salustiano; K K de Andrade; H Sangi-Haghpeykar; E Carreras; M A Belfort
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study     Date:  2013-09-02
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  42     ISSN:  1469-0705     ISO Abbreviation:  Ultrasound Obstet Gynecol     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-09-30     Completed Date:  2014-04-01     Revised Date:  2014-09-16    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  England    
Other Details:
Languages:  eng     Pagination:  434-9     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.
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MeSH Terms
Descriptor/Qualifier:
Adult
Arteriovenous Anastomosis / surgery
Female
Fetofetal Transfusion / surgery*
Fetoscopy / methods*
Humans
Laser Coagulation / methods*
Placenta / blood supply,  surgery
Polycythemia / prevention & control
Polyhydramnios / prevention & control
Pregnancy
Pregnancy Outcome
Pregnancy, Twin
Recurrence / prevention & control
Retrospective Studies
Comments/Corrections
Comment In:
Ultrasound Obstet Gynecol. 2014 Aug;44(2):244   [PMID:  25088513 ]
Ultrasound Obstet Gynecol. 2014 Feb;43(2):238-9   [PMID:  24497423 ]
Ultrasound Obstet Gynecol. 2014 Feb;43(2):239-40   [PMID:  24497424 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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