Document Detail

Social and economic factors influencing a fetal surgery program for complicated monochorionic twin pregnancies in a developing country.
MedLine Citation:
PMID:  21358168     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To analyze social and economic factors affecting the implementation of a fetal surgery program in a developing country.
MATERIALS AND METHODS: During an 18-month period, 30 women with complicated monochorionic diamniotic twin pregnancies were evaluated. 27 women had twin-to-twin transfusion syndrome (TTTS), 2 women had a selective intrauterine growth restriction, and 1 a discordant twin pregnancy with 1 fetus with a severe open neural tube defect. The TTTS cases were treated with fetoscopic laser ablation of the interplacental vascular communications and the remaining 3 cases with bipolar cord occlusion of the affected twin. The patients were evaluated using family income levels (very low, low, median, and high income). Demographic characteristics, gestational age at referral, the prevalence of infections, tocolysis care with hospital readmission, prolonged hospital stay until delivery, and gestational age at delivery were evaluated.
RESULTS: The overall survival rate of fetuses treated with laser ablation was 60% (32/54). Survival of at least 1 twin was achieved in 21/27 pregnancies (77%), and survival of both twins in 12/27 pregnancies (44%). The 3 pregnancies treated with cord occlusion had survival of the normal twin. Patients with low and very low family income showed a significantly higher prevalence of vaginal infections, increased periods of tocolysis requiring hospitalization, prolonged hospital stay until the end of pregnancy, and lower gestational age at delivery.
CONCLUSION: When a fetal surgery program is implemented in a developing country, social and economic factors will influence the overall healthcare costs and treatment outcomes.
E Hernandez-Andrade; J A Benavides-Serralde; M E Guzmán Huerta; O Moreno-Alvarez; J Mancilla-Ramírez
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-02-25
Journal Detail:
Title:  Fetal diagnosis and therapy     Volume:  29     ISSN:  1421-9964     ISO Abbreviation:  Fetal. Diagn. Ther.     Publication Date:  2011  
Date Detail:
Created Date:  2011-04-15     Completed Date:  2011-08-03     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  9107463     Medline TA:  Fetal Diagn Ther     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  224-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 S. Karger AG, Basel.
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MeSH Terms
Developing Countries*
Fetal Growth Retardation / surgery*
Fetofetal Transfusion / surgery*
Pregnancy Complications, Infectious / epidemiology
Pregnancy, Multiple*
Socioeconomic Factors
Treatment Outcome

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