Fetoscopic surgery in triplet pregnancies: A multicenter case series

Schoubroeck, Dominique Van; Lewi, Liesbeth; Ryan, Greg; Carreras, Elena; Jani, Jacques; Higueras, Teresa; Deprest, Jan; Gratacós, Eduard

doi:10.1016/j.ajog.2004.06.039

Cited by 41 publications

(52 citation statements)

References 23 publications

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“…Early attempts were highly invasive and involved hysterotomy and removal of the acardiac twin [2,3,4]. Subsequently, a series of other less invasive intrauterine interventions aiming to arrest the circulation of the acardiac twin were introduced [5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75]. These included insertion of cord coils, ligation with or without transection of the umbilical cord, endoscopic laser coagulation of placental anastomoses between the pump and acardiac twins, endoscopic laser coagulation and endoscopic or ultrasound-guided monopolar or bipolar diathermy of vessels within the cord supplying the acardiac twin and, more recently, ultrasound-guided ablation of intrafetal vessels by injection of alcohol, monopolar diathermy, laser or radiofrequency.…”

Section: Introductionmentioning

confidence: 99%

Optimal Method and Timing of Intrauterine Intervention in Twin Reversed Arterial Perfusion Sequence: Case Study and Meta-Analysis

et al. 2014

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Introduction: The objective of this study was to define the optimal method and timing of intervention in twin reversed arterial perfusion (TRAP) sequence. Material and Methods: During a period of 20 years (1993-2013), we performed endoscopic laser coagulation of umbilical cord vessels or intrafetal laser in 67 pregnancies with TRAP sequence. These data were combined with those reported in the literature to determine the survival rate of the pump twin for different methods and timing of interventions. Results: A variety of techniques were used to interrupt the blood supply to the acardiac twin. Most procedures were performed at or after 16 weeks, and with most methods the survival rate of the pump twin was about 80%. Good results were also obtained for triplet pregnancies. In 18 of 30 cases (60%) diagnosed at 11-14 weeks, there was spontaneous cessation of flow in the acardiac twin before planned intervention at 16-18 weeks, and in 11 of these (61.1%) the pump twin died or suffered brain damage. In 103 pregnancies treated by intrafetal laser at 12-27 weeks, there was no correlation between gestational age at treatment and survival rate, but there was an inverse association between gestational age at treatment and gestational age at birth. Discussion: In TRAP sequence, survival may be improved by elective intervention at 12-14 weeks.

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Section: Introductionmentioning

confidence: 99%

Optimal Method and Timing of Intrauterine Intervention in Twin Reversed Arterial Perfusion Sequence: Case Study and Meta-Analysis

et al. 2014

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“…Previous case series on laser therapy in triplets with severe TTTS include 10 cases from a single center 6 and another six cases as part of a multicenter report on fetoscopic surgery in triplets 7 . We report a single-center experience with endoscopic laser ablation of placental anastomoses in 20 triplet pregnancies complicated by TTTS.…”

Section: Introductionmentioning

confidence: 99%

Laser therapy of twin‐to‐twin transfusion syndrome in triplet pregnancies

Diemert

Diehl

Huber

et al. 2009

Ultrasound in Obstet & Gyne

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“…The literature search identified 8 previous studies reporting data on DCTA pregnancies with FFTS treated by endoscopic laser surgery, and the combined data from these studies with ours are shown in table 2 and figure 1 [9][10][11][12][13][14][15][16] . In a total of 132 such pregnancies, the pooled survival rate of at least one baby was 94.4% (95% CI 90.1-97.6), and the overall survival for all babies was 76.1% (95% CI 71.9-80.2); there was no significant heterogeneity between the studies.…”

Section: Synthesis With Results From Previous Studiesmentioning

confidence: 99%

“…In sFGR with abnormal Doppler findings in the umbilical artery of the affected fetus, there is a high risk of perinatal death and handicap for both twins; the management for affected pregnancies presenting at midgestation includes endoscopic laser coagulation of the inter-twin communicating placental vessels or cord occlusion of the FGR twin [4][5][6][7][8] . Few studies in a small number of patients have reported on endoscopic laser coagulation of communicating placental vessels for the management of FFTS in MC or dichorionic (DC) triamniotic (TA) triplet pregnancies complicated by FFTS [9][10][11][12][13][14][15][16] .…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Placental Laser Coagulation in Dichorionic and Monochorionic Triplet Pregnancies

Peeva

Chaveeva²,

Guevara³

et al. 2016

Fetal Diagn Ther

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Objective: To report the outcome of monochorionic (MC) and dichorionic (DC) triamniotic (TA) triplet pregnancies treated with endoscopic laser coagulation of the communicating placental vessels for severe feto-fetal transfusion syndrome (FFTS) and selective fetal growth restriction (sFGR). Methods: Laser surgery was performed at 18 (15-24) weeks' gestation in 11 MCTA and 33 DCTA pregnancies complicated by FFTS and 14 DCTA pregnancies complicated by sFGR. Data from our study and previous reports were pooled using meta-analytic techniques. Results: Survival of at least one baby and survival among all fetuses was 97.0 and 72.7% in DCTA pregnancies with FFTS, 78.6 and 52.4% in DCTA pregnancies with sFGR and 81.8 and 39.4% in MCTA pregnancies with FFTS. In the combined data from our study and previous reports, the pooled survival rates in 132 DCTA pregnancies with FFTS were 94.4 and 76.1%, and in 29 MCTA pregnancies with FFTS, they were 80.6 and 57.5%. Conclusions: Survival after laser surgery is higher in DC triplets with FFTS than in those with sFGR and in DC than in MC triplets with FFTS.

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Fetoscopic surgery in triplet pregnancies: A multicenter case series

Cited by 41 publications

References 23 publications

Optimal Method and Timing of Intrauterine Intervention in Twin Reversed Arterial Perfusion Sequence: Case Study and Meta-Analysis

Optimal Method and Timing of Intrauterine Intervention in Twin Reversed Arterial Perfusion Sequence: Case Study and Meta-Analysis

Laser therapy of twin‐to‐twin transfusion syndrome in triplet pregnancies

Endoscopic Placental Laser Coagulation in Dichorionic and Monochorionic Triplet Pregnancies

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