Document Detail


Third trimester fetoscopic laser ablation of type II vasa previa.
MedLine Citation:
PMID:  19637106     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Vasa previa is associated with increased perinatal morbidity and mortality because of fetal exsanguination at time of membrane rupture. We report our experience in the treatment of type II vasa previa via in utero laser ablation in the third trimester. METHODS: Two cases of type II vasa previa were identified via endovaginal ultrasound in the second trimester and treated via third trimester fetoscopic laser ablation. RESULTS: In case 1, fetoscopic laser ablation of the vasa previa was performed without complication at 28 3/7 weeks' gestation as a prophylactic measure. The patient delivered at 33 3/7 weeks' gestation after rupture of membranes without sequelae with good perinatal outcome. In case 2, expectant management of twins with a vasa previa was planned. However, significant cervical shortening and funneling was documented at 30 5/7 weeks', and the risk of membrane rupture was deemed relatively high. As a therapeutic alternative to outright preterm delivery, the patient underwent uncomplicated laser ablation of the vasa previa. Delivery occurred at 34 3/7 weeks' after rupture of membranes, and the twins did well. CONCLUSIONS: We suggest that type II vasa previa can be definitively treated in utero by laser photocoagulation in the third trimester. Ablation of the vasa previa may be performed prophylactically or as a therapeutic measure to delay delivery if symptoms of preterm labor and/or cervical shortening develop.
Authors:
Ramen H Chmait; Emiliano Chavira; Eftichia V Kontopoulos; Rubén A Quintero
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians     Volume:  23     ISSN:  1476-4954     ISO Abbreviation:  J. Matern. Fetal. Neonatal. Med.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-18     Completed Date:  2010-09-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101136916     Medline TA:  J Matern Fetal Neonatal Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  459-62     Citation Subset:  IM    
Affiliation:
Department of Obstetrics and Gynecology, Keck School of Medicine, University Southern California, Los Angeles, California 90027, USA. chmait@usc.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Female
Fetoscopy / methods*
Humans
Infant, Newborn
Laser Therapy / methods*
Pregnancy
Pregnancy Trimester, Third* / physiology
Treatment Outcome
Ultrasonography, Prenatal
Vasa Previa / surgery*,  ultrasonography

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


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