Active management of selective intrauterine growth restriction with abnormal Doppler in monochorionic diamniotic twin pregnancies diagnosed in the second trimester of pregnancy

Chalouhi, G. E.; Marangoni, M.; Quibel, T.; Deloison, B.; Benzina, N.; Essaoui, M.; Ibrahim, Abdullah Al; Stirnemann, J.; Salomon, Laurent; Ville, Y.

doi:10.1002/pd.4031

Cited by 60 publications

(81 citation statements)

References 64 publications

(88 reference statements)

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“…In the cases of sFGR without TTTS, we did not undertake amnioinfusion, as previously described [10]. A 400-µm diameter Nd:YAG laser fibre (Dornier Med Tech, Wessling, Germany) with a power output of 40 W was used to coagulate the inter-twin communicating placental vessels.…”

Section: Methodsmentioning

confidence: 99%

“…In type I sFGR without TTTS, expectant management with close monitoring to define the best time of delivery is associated with good perinatal outcome for both twins [2,7]. In types II and III sFGR without TTTS, there is a high risk of perinatal death and handicap for both twins; the best management, which includes early delivery, cord occlusion of the FGR twin or endoscopic laser surgery, is uncertain because of the small number of reported cases [2,7,8,9,10,11]. …”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Placental Laser Coagulation in Monochorionic Diamniotic Twins with Type II Selective Fetal Growth Restriction

Peeva¹,

Bower²,

Orosz³

et al. 2015

Fetal Diagn Ther

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Objective: To determine predictors of survival in monochorionic diamniotic twins with selective fetal growth restriction type II (sFGR-II), with or without twin-to-twin transfusion syndrome (TTTS), treated by endoscopic placental laser coagulation. Methods: Laser surgery was performed at 20 (15-27) weeks' gestation in 405 cases of sFGR-II with and 142 without coexisting TTTS. Multivariable logistic regression analysis was performed to determine significant predictors of survival to discharge from hospital. Results: There was survival of the small twin in 216 (39.5%) and of the large twin in 379 (69.3%) cases. Significant predictors of survival of both the small and larger twin were ductus venosus Doppler findings in the small twin, gestational age at laser and cervical length, but not the presence of TTTS or Doppler findings in the large twin. Conclusions: In sFGR-II, survival after laser surgery is primarily dependent on the condition of the small twin.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endoscopic Placental Laser Coagulation in Monochorionic Diamniotic Twins with Type II Selective Fetal Growth Restriction

Peeva¹,

Bower²,

Orosz³

et al. 2015

Fetal Diagn Ther

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show abstract

“…Chalouhi et al 56 compararon la terapéutica utilizada en 45 gestaciones complicadas con RCIUs tipo II y III, de las cuales 23 fueron sometidas a fotocoagulación laser selectiva de las anastomosis placentarias y 22 a fotocoagulación del cordón umbilical produciendo el feticidio selectivo, concluyeron que ambas fueron beneficiosas al considerar una supervivencia global de 52,17% y 45,45% respectivamente; sin embargo, al analizar la supervivencia del gemelo de tamaño normal, fue mayor en el grupo de coagulación del cordón umbilical (90,9% vs 74%) además de conseguir la sobrevida del gemelo pequeño en el 30% de los casos. Por lo tanto, el láser en RCIUs es una opción viable, pero requiere un mayor nivel de experiencia y habilidades quirúrgicas que en el STFF, y el resultado es menos efectivo que con la oclusión del cordón.…”

Section: Visentin Et Alunclassified

Selective intrauterine growth restriction in monochorionic-diamniotic twins: diagnosis and management

Cosp

2016

Rev. Nac. (Itauguá)

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RESUMENLa Restricción Selectiva del Crecimiento Intrauterino se produce en 10 a 19% de los gemelos monocoriónicos y se asocia con un aumento importante de la mortalidad y la morbilidad perinatal. La evolución clínica está dada en gran parte por la presencia de anastomosis vaculares y la distribución placentaria asimétrica. Se propuso una clasificación en tres tipos según el Doppler de la arteria umbilical del gemelo más pequeño, la que sé que se correlaciona con distintos comportamientos clínicos y características de la placenta, lo que ayuda en el asesoramiento y conducta obstétrica. Los del tipo I tienen un pronóstico favorable por el resultado perinatal satisfactorio por lo que se recomienda un seguimiento cercano por ecografía y Doppler. Los de tipo II tienen un mal pronóstico y el tipo III un pronóstico intermedio e impredecible. En estos dos últimos se puede realizar un manejo expectante hasta que se observe deterioro del feto pequeño, considerando la posibilidad de la coagulación con láser o la oclusión del cordón (feticidio selectivo). Ambas conductas aparentemente aumentan las posibilidades de supervivencia del feto de peso normal.Palabras claves: restricción selectiva del crecimiento intrauterino, diagnóstico, manejo, gemelos monocoriales, doppler, terapia fetal ABSTRACT Selective intrauterine growth restriction occurs in 10-19% of monochorionic twins and is associated with increased mortality important and perinatal morbidity. The clinical course is given largely by the presence of placental vascular anastomosis and asymmetric distribution. It classified into three types according to the proposed Doppler umbilical artery smaller twin, the one that correlates with different clinical behaviors and characteristics of the placenta, which helps in counseling and obstetric conduct. The type I have a favorable prognosis for satisfactory perinatal outcome so closely monitored by ultrasound and Doppler is recommended. The type II has a poor prognosis and type III intermediate and unpredictable prognosis. In these last two you can make an expectant management until deterioration of the small fetus is observed, considering laser coagulation or cord occlusion(selective feticide). Both behaviors appear to increase the chances of survival of the fetus of normal weight.

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“…В дополнение к этим уникальным проблемам тяжелая задержка развития одно-го из плодов или тяжелый порок развития у одного из пло-дов также являются другими сложными вопросами моно-хориальной беременности, при которых выполнение се-лективного фетоцида становится оптимальным методом, позволяющим избежать развития возможных осложнений у второго плода [1][2][3][4]. Селективный фетоцид широко ис-пользуется во многих странах мира при дискордантности плодов по пороку развития или по хромосомному заболе-ванию.…”

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Selective feticide in complicated monochorionic twin or dichorionic triplet pregnancies applying laser coagulation of umbilical cord vessels

Kosovtsova¹,

Башмакова²,

Маркова³

et al. 2016

Ross. vestn. akush.-ginekol.

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Active management of selective intrauterine growth restriction with abnormal Doppler in monochorionic diamniotic twin pregnancies diagnosed in the second trimester of pregnancy

Cited by 60 publications

References 64 publications

Endoscopic Placental Laser Coagulation in Monochorionic Diamniotic Twins with Type II Selective Fetal Growth Restriction

Endoscopic Placental Laser Coagulation in Monochorionic Diamniotic Twins with Type II Selective Fetal Growth Restriction

Selective intrauterine growth restriction in monochorionic-diamniotic twins: diagnosis and management

Selective feticide in complicated monochorionic twin or dichorionic triplet pregnancies applying laser coagulation of umbilical cord vessels

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