Complicated monochorionic twin pregnancies: Experience with bipolar cord coagulation

Nicolini, Umberto; Poblete, Andrés; Boschetto, Chiara; Bonati, Francesca; Roberts, Alistair

doi:10.1067/mob.2001.117190

Cited by 89 publications

(47 citation statements)

References 8 publications

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“…4 -6 All six infants with severe malformations in the co-twin survived. 5 Where TTTS was the indication, although eligibility criteria differed, 26 of 32 co-twins survived. 4 -7 The overall survival rate was 82%.…”

Section: Discussionmentioning

confidence: 99%

Selective feticide in complicated monochorionic twin pregnancies using ultrasound‐guided bipolar cord coagulation

Robyr¹,

Yamamoto²,

Ville³

2005

BJOG

107

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Objective To review our experience with selective feticide in complicated monochorionic (MC) twin pregnancies, using ultrasound-guided cord coagulation with a bipolar forceps. Design Retrospective analysis.Setting All consecutive umbilical cord coagulations performed at our institution in the second trimester of pregnancy between November 1999 and 2003. Population Consecutive cases of complicated MC pregnancies with an indication for selective termination.Methods Ultrasound-guided coagulation of the umbilical cord with a 2.5-mm bipolar forceps under local anaesthesia. Main outcome measures Indications, gestational age at the procedure, perinatal outcome and neonatal follow up. Results Forty-six patients with MC twin pregnancies underwent this procedure. Indications included twin reverse arterial perfusion sequence (n ¼ 17), severe malformation in one twin (n ¼ 7) and agonal presentation or cerebral anomalies of one twin in twin-to-twin transfusion syndrome (TTTS) after laser treatment or serial amniodrainage (n ¼ 22). The procedure resulted in six intrauterine fetal demise (IUFD, 13%), with a rate of 41% and 3% when performed at 16 -17 weeks or later, respectively (Fisher P ¼ 0.002). Preterm rupture of the membranes (PROM) before 28 weeks and between 28 and 34 weeks occurred in 9% and 14% of the cases, respectively. All neonatal deaths (four) occurred in cases with PROM at 28 weeks or earlier. Paediatric follow up showed that all infants discharged alive but one were neurologically normal at 3 -42 months, which corresponds to 70% of the 46 cases. Conclusions This technique is effective when the natural history is likely to severely affect the development of the normal co-twin. The overall intact survival rate was 70% and our results support justification of later surgery. Prematurity remains a significant complication of the procedure.

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Section: Discussionmentioning

confidence: 99%

Selective feticide in complicated monochorionic twin pregnancies using ultrasound‐guided bipolar cord coagulation

Robyr¹,

Yamamoto²,

Ville³

2005

BJOG

107

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“…1). Показаниями к коагуляции сосудов пуповины в данном исследовании послужили синдром обратной артериаль-ной перфузии (11 случаев), множественные врожденные пороки развития (МВПР) плода из монохориальной двой-ни/дихориальной тройни (3), III-IV степень ФФТС в со-четании с ВПР (2) или СЗВУР плода, составляющей более 50% от массы большего плода (12), СЗВУР плода при мо-нохориальной диамниотической двойне с критическим кровотоком у плода (9), супермногоплодие (1), рецидив ФФТС после коагуляции плацентарных анастомозов (2). Результаты эффективности данной процедуры составили 95%, неблагоприятные исходы наблюдались в 6 (15%) слу-чаях.…”

Section: результаты и обсуждениеunclassified

“…Проце-дура может выполняться с использованием различных ме-тодик: инъекции 96° этанола во внутрибрюшную часть артерии пуповины, перевязки пуповины при фетоскопии, биполярной коагуляции сосудов пуповины, радиочастот-ной аблации сосудов пуповины, введения в артерии пупо-вины под эхографическим контролем тромбогенной спи-рали, введения эмболов в кровеносную систему акарди-ального плода, гистеротомии и селективного родоразре-шения акардиального плода [10][11][12][13][14]. Лазерная коагуля-ция сосудов пуповины под контролем ультразвукового и фетоскопического исследования применяется в ФГБУ «Уральский научно-исследовательский институт охраны материнства и младенчества» (НИИ ОММ) МЗ РФ с 2010 г.…”

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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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“…Other risks involve preterm prelabor rupture of membranes, chorioamnionitis and maternal mirror syndrome. [9][10][11][12] For anomalies with a high likelihood of intrauterine fetal death (IUFD), selective feticide may be specifically justified as a therapeutic intervention for the unaffected twin. Sudden IUFDs not directly related to the cardiac condition cannot be predicted, and should be made clear to the parents.…”

Section: Medical Issuesmentioning

confidence: 99%

Medical and ethical considerations in twin pregnancies discordant for serious cardiac disease

et al. 2009

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Objective: Prenatal ultrasound has led to the early diagnosis of major anomalies. However, the ready availability of this technology has led to increasing challenges for physicians counseling affected parents, which is all the more difficult in a twin pregnancy with only one affected fetus. This paper reviews the medical and ethical considerations in twin pregnancies discordant for a serious cardiac condition.Study Design: Six recent twin pregnancies discordant for a serious cardiac condition and their outcomes are presented. Options considered in the management of the pregnancy were to continue or terminate the pregnancy, selectively terminate the affected twin or to decide whether to treat the affected twin once delivered. An approach to decision making in such situations has been formulated after critical analysis of the factors involved.Results: Four of the six pregnancies were monochorionic twins. Two sets of parents decided to terminate the pregnancy. In the four that continued, two opted for the affected twin to be appropriately managed once delivered. A further two considered selective termination but opted to continue the pregnancy because of the risk of premature labor and/or cerebral hypoxia following such intervention. They sought a commitment, however, that they be given the option whether to treat the affected twin following delivery. Eventually both elected to have their babies treated, one of whom died in the postoperative period.Discussion: Medical considerations included the risks of continuation of the pregnancy for the mother and her twins, the safety of termination (total or selective), and the risks to the unaffected fetus. Ethical issues revolved around concepts of autonomy, beneficence and justice from the standpoint of the family and the twins. The gestation and the viability of the twins played an important role in decision making and approaches, taking into account the local legal and other considerations. Conclusion:Attention is drawn to the complexities of the issues involved in twin pregnancies complicated by a serious cardiac condition in one of the twins. Optimal counseling requires sound clinical knowledge about the medical risks to the mother and her twins, and a clear understanding of the key ethical considerations. Such an approach will assist parents in their very difficult decision making.

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Complicated monochorionic twin pregnancies: Experience with bipolar cord coagulation

Cited by 89 publications

References 8 publications

Selective feticide in complicated monochorionic twin pregnancies using ultrasound‐guided bipolar cord coagulation

Selective feticide in complicated monochorionic twin pregnancies using ultrasound‐guided bipolar cord coagulation

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

Medical and ethical considerations in twin pregnancies discordant for serious cardiac disease

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