A Modified Technique for Cord Transection in Monochorionic Monoamniotic Twin Pregnancies

Greimel, Patrick; Csapó, B; Haeusler, Martin; Lang, Uwe; Klaritsch, Philipp

doi:10.1159/000489882

Cited by 12 publications

(5 citation statements)

References 20 publications

(31 reference statements)

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“…4 To reduce the risk of cord prolapse for the remaining fetus, fetoscopic cord transection of the deceased fetus may be considered on a case-by-case basis. 2,19 There is still no consensus in the evidence regarding the management and mode of delivery of these rare cases.…”

Section: Discussionmentioning

confidence: 99%

The management of Monochorionic Monoamniotic (MCMA) twin pregnancy

Ernawati,

Qonitatillah,

Sulistyono

2023

MOG

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HIGHLIGHTS Monochorionic monoamniotic (MCMA) twin pregnancy has a significant risk of perinatal morbidity and mortality, including intrauterine fetal death (IUFD). The risk of prematurity, the risk of death due to MCMA complications, the availability of the NICU, also high costs on preterm care were factors in deciding to terminate the pregnancy. The ideal time to deliver monochorionic twins in order to reduce the risks of cord entanglement, growth discrepancies, and intrauterine fetal death is still a point of controversy. Early diagnosis, intensive antenatal monitoring, patient and family decision would contribute to antenatal mortality reduction. ABSTRACT Objectives: To present the management of monochorionic monoamniotic (MCMA) twin pregnancy. Case Report: Advanced prenatal treatment has improved the prognosis for Monochorionic Monoamniotic (MCMA) pregnancies; however, there is still no agreement on how to handle MCMA twins. The authors report 2 cases of monoamniotic monochorionic twin pregnancies. In the first case, a 30-years-old primi pregnant woman detected MCMA at 14 weeks of gestation; no complications related to MCMA were found; she planned delivery at 32 weeks, but one of the babies died in the womb at 31/32 weeks pregnant, a live baby born by cesarean section. The second case was a 36-year-old pregnant woman, on her third pregnancy, diagnosed with MCMA after 12 weeks of pregnancy, no complications related to MCMA, the baby was born at 32 weeks pregnant, and both babies survived. The management was the same in both cases, but different outcomes were obtained; in case 1, the baby died allegedly due to cord entanglement, which could not be detected during pregnancy.

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Section: Discussionmentioning

confidence: 99%

The management of Monochorionic Monoamniotic (MCMA) twin pregnancy

Ernawati,

Qonitatillah,

Sulistyono

2023

MOG

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“…Manipulation of the umbilical cord with sole contact laser led to violation of a nonoccluded part of the umbilical cord with severe bleeding and exsanguination of the pump twin. Subsequent to this case we adopted a transection technique described by Greimel et al [18] using a 3-Fr grasping forceps in addition to the laser fiber in order to allow a controlled manipulation of the umbilical cord during the procedure. Due to Doppler artifacts, it is often challenging to determine the absence of blood flow in the umbilical cord.…”

Section: Discussionmentioning

confidence: 99%

“…The umbilical cord was transected in contact mode with the bare tip of the laser fiber. After 2017, a 3-Fr grasping forceps was used in addition to the laser fiber in order to allow controlled manipulation of the umbilical cord during the procedure [9, 13]. Choice and timing of the intervention were decided on an individual basis after discussion with the patient and taking into consideration individual risk factors.…”

Section: Methodsmentioning

confidence: 99%

Outcome of Monochorionic Monoamniotic Twin Reversed Arterial Perfusion Sequence Diagnosed in the First Trimester

et al. 2021

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Introduction: The aim of this study is to evaluate the outcome of pregnancies complicated by monochorionic monoamniotic twin reversed arterial perfusion sequence (MOMA TRAP) diagnosed in the first trimester. Methods: All patients diagnosed with MOMA TRAP sequence <14.0 weeks of gestation in a 10-year study period were retrospectively analyzed for intrauterine course and outcome. All patients were offered either expectant management or intrauterine intervention. Adverse outcome was defined as either intrauterine death (IUD), neonatal death or preterm birth <34.0 weeks of gestation. Results: In the study period, 17 cases with MOMA TRAP sequence were diagnosed. Of these, 2 couples opted for termination of pregnancy. The remaining 15 were divided into 2 groups depending on the management: group A (n = 8) with expectant management and group B (n = 7) with intrauterine intervention. All fetuses in group A died before 20 weeks. Survival in group B was significantly better with 4/7 (57.1%) life births at a median of 39.6 weeks of gestation (p = 0.0256). The reasons for IUD in the 3 cases in group B were hemodynamic, strangulation, and bleeding complications during intervention. Conclusions: Intrauterine intervention in MOMA TRAP pregnancies significantly improves neonatal survival, although it is still associated with a substantial risk for IUD by hemodynamic complications or entanglement.

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“…Thereafter, following the report of Greimel et al 2018, we used a 3 Charr. grasping forceps (11510 C, Storz, Tuttlingen, Germany) to allow controlled manipulation of the umbilical cord during the procedure resulting in shorter intervention time ( Figure 2 ) [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

Outcome of Monochorionic Pregnancies after Selective Feticide with Bipolar Cord Coagulation: A German Single Center Experience

Weber

Strizek

Recker

et al. 2022

JCM

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Objectives: To review the outcome of complicated monochorionic pregnancies after fetoscopic selective feticide with bipolar cord coagulation in an experienced German center. Methods: All cases that underwent selective feticide using fetoscopic bipolar umbilical cord occlusion (and simultaneous dissection in monoamniotics) at the University of Bonn in the past 10 years were retrospectively analyzed for antenatal and neonatal course and outcome. An adverse outcome was defined as either intrauterine death (IUD), neonatal death (NND), preterm prelabour rupture of membranes (PPROM), or preterm delivery (PTD) before 32.0 weeks of gestation. Results: We diagnosed 56 monochorionic pregnancies, including 43 diamniotic and 8 monoamniotic twins, as well as 5 triplets, complicated by discordant fetal anomalies (n = 10), selective intrauterine growth restriction (n = 29), twin-to-twin transfusion syndrome (n = 13), twin reversed arterial perfusion sequence (n = 3), or severe early twin anemia polycythemia sequence (n = 1), that underwent fetoscopic selective feticide in the 10 years study period. Selective feticide was performed by bipolar cord coagulation at a median gestational age of 21.2 weeks. PPROM occurred in 11 cases, 7 (12.5%) before 32.0 weeks and 4 (7.1%) between 34.0 and 36.0 weeks, respectively. There were five (8.9%) co-twins IUDs at a median of 2 weeks after the intervention. We observed 12 (21.4%) PTDs before 32.0 weeks of gestation and 2 (3.6%) NNDs. Mean gestational age at delivery was 37.1 weeks, with an overall survival of the co-twin of 87.5%. Conclusion: In experienced hands, fetoscopic selective feticide is an effective treatment in complicated monochorionic pregnancies. By sacrificing a sick fetus that jeopardizes the entire pregnancy, a higher survival rate of the co-twin can be achieved.

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A Modified Technique for Cord Transection in Monochorionic Monoamniotic Twin Pregnancies

Cited by 12 publications

References 20 publications

The management of Monochorionic Monoamniotic (MCMA) twin pregnancy

The management of Monochorionic Monoamniotic (MCMA) twin pregnancy

Outcome of Monochorionic Monoamniotic Twin Reversed Arterial Perfusion Sequence Diagnosed in the First Trimester

Outcome of Monochorionic Pregnancies after Selective Feticide with Bipolar Cord Coagulation: A German Single Center Experience

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