Document Detail


Severe twin-twin transfusion syndrome: outcome after fetoscopic laser ablation of the placental vascular equator.
MedLine Citation:
PMID:  17516959     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To assess the safety and efficacy of a modified fetoscopic laser ablation technique for the management of severe twin-twin transfusion syndrome (TTTS) in a large series of pregnancies. DESIGN: Prospective cohort study. SETTING: Tertiary referral fetal medicine unit. POPULATION: Women with pregnancies complicated by severe TTTS (Quintero stage III or IV), before 26 weeks of gestation. METHODS: Fetoscopic laser ablation of placental anastomoses was performed. The sonoendoscopic approach was used to identify the placental vascular equator and to photocoagulate crossing vessels. MAIN OUTCOME MEASURES: Overall survival, fetal and perinatal mortalities, gestational age at delivery, birthweight, operating time and recurrence of TTTS. RESULTS: A total of 77 women underwent the procedure. The mean gestational age at treatment was 20 (range 16-26) weeks. On average, four vessels were ablated during each procedure, with a mean operative time of 15 (range 5-25) minutes. None of the women required a repeat fetoscopic laser treatment for recurrence of the TTTS. There was at least one survivor in 74% (57/77) of pregnancies, and the overall survival rate was 57% (88/154). CONCLUSIONS: Fetoscopic laser ablation is a safe and effective form of treatment in the management of severe TTTS. The technique of identifying the common villous district of the placenta by ultrasound and photocoagulating any vessels crossing the vascular equator appears to be an acceptable alternative to both the nonselective and highly selective methods described so far. This approach is associated with a short operating time, low likelihood of TTTS recurrence or fetal anaemia and with survival results that are equivalent to previously reported techniques.
Authors:
A M Ierullo; A T Papageorghiou; A Bhide; N Fratelli; B Thilaganathan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  BJOG : an international journal of obstetrics and gynaecology     Volume:  114     ISSN:  1471-0528     ISO Abbreviation:  BJOG     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-05-22     Completed Date:  2007-06-07     Revised Date:  2007-10-19    
Medline Journal Info:
Nlm Unique ID:  100935741     Medline TA:  BJOG     Country:  England    
Other Details:
Languages:  eng     Pagination:  689-93     Citation Subset:  AIM; IM    
Affiliation:
Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's Hospital NHS Trust, London, UK.
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MeSH Terms
Descriptor/Qualifier:
Cohort Studies
Female
Fetofetal Transfusion / surgery*
Fetoscopy / methods*
Gestational Age
Humans
Laser Coagulation / methods*
Length of Stay
Placenta / surgery*
Pregnancy
Pregnancy Trimester, Second
Pregnancy, Multiple*
Prenatal Care / methods*
Prospective Studies
Twins
Comments/Corrections
Comment In:
BJOG. 2007 Oct;114(10):1306; author reply 1306-7   [PMID:  17877693 ]

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


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