Improved recipient survival with maternal nifedipine in twin-twin transfusion syndrome complicated by TTTS cardiomyopathy undergoing selective fetoscopic laser photocoagulation

Crombleholme, Timothy M.; Lim, Foong‐Yen; Habli, Mounira; Polzin, William; Jaekle, Ronald; Michelfelder, Erik C.; Cnota, James; Liu, Chunyan; Kim, Miok

doi:10.1016/j.ajog.2010.06.032

Cited by 17 publications

(19 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Talbert et al ( 1996 ) , as well as Bajoria et al ( 2002Bajoria et al ( , 2003 , found elevated atrial natriuretic peptide and endothelin-1 levels in the recipient twin and inferred it to be a sequel of failing heart in the recipient, perhaps also being important for amnionic fl uid regulation (see also Habli et al 2010 ) . Moreover, Crombleholme et al ( 2010 ) have suggested that the recipient's survival improved when maternal nifedipine therapy was instituted 1-2 days prior to laser ablations. This prenatal unidirectional exchange of blood results in deprivation of nutrients from one twin and excessive development of the other.…”

Section: Twin-to-twin Transfusion Syndromementioning

confidence: 99%

Multiple Pregnancies

Benirschke¹,

Burton²,

Baergen³

2012

Pathology of the Human Placenta

View full text Add to dashboard Cite

Section: Twin-to-twin Transfusion Syndromementioning

confidence: 99%

Multiple Pregnancies

Benirschke¹,

Burton²,

Baergen³

2012

Pathology of the Human Placenta

View full text Add to dashboard Cite

“…Since a previous study [4] demonstrated a different survival rate for the recipient twin in patients who were exposed and not exposed to nifedipine, only nifedipine exposure patients were included in this part of the analysis. The acute survival rate of the recipient and donor twin was determined by ultrasound or fetal echocardiogram performed on days 3–5 after SFLP [4]. The survival rate at birth of the recipient twin and donor twins was defined as live birth at delivery.…”

Section: Methodsmentioning

confidence: 99%

“…Nifedipine given via the mother has been used for the treatment of fetal hypertensive cardiomyopathy, in order to improve recipient twin survival rate after SFLP [4]. Nifedipine is also a tocolytic drug with 77% placental transfer [12].…”

Section: Commentmentioning

confidence: 99%

See 1 more Smart Citation

Maternal Hypotension during Fetoscopic Surgery: Incidence and Its Impact on Fetal Survival Outcomes

Ngamprasertwong

Habli

Boat

et al. 2013

The Scientific World Journal

Self Cite

View full text Add to dashboard Cite

In this retrospective cohort study, we aimed to determine the incidence of intraoperative maternal hypotension during fetoscopic surgery for twin-twin transfusion syndrome (TTTS) and to evaluate the impact of intraoperative hypotension on fetal survival. A total of 328 TTTS patients with recipient twin cardiomyopathy who underwent fetoscopic surgery under epidural anesthesia were included. The exposure of interest was maternal medical therapy with nifedipine for the treatment of fetal cardiomyopathy. We found that intraoperative hypotension occurred in 53.4% (175/328 patients). There was no statistically significant difference in incidence of hypotension between nifedipine exposure and nonexposure groups (54.8% versus 50.8%, P = 0.479). However, the nifedipine exposure group received a statistically significant higher dose of phenylephrine (7.04 ± 6.38 mcg/kg versus 4.70 ± 4.14 mcg/kg, P = 0.018) and higher doses of other vasopressor, as counted by number of treatments (6.06 ± 4.58 versus 4.96 ± 3.42, P = 0.022). There were no statistically significant differences in acute fetal survival rate (within 5 days) and fetal survival rate at birth between hypotensive and nonhypotensive patients. We concluded that preoperative exposure to nifedipine resulted in increased intraoperative maternal vasopressor requirement during fetoscopic surgery under epidural anesthesia. In patients who had intraoperative maternal hypotension, there was no correlation between the presence of maternal hypotension and postoperative fetal survival.

show abstract

“…64,133134 Postoperatively fetal demise of the recipient twin is more common when reversed awave in the ductus venosus, or hydrops occurs. 135 Some studies show improved survival rate of the recipient twin with administration of nifedipine 24 to 48 hours prior to laser photocoagulation, especially in cases with twin to twin transfusion syndrome cardiomyopathy. 136 If recipient cardiomyopathy exists the time needed for cardiac function back to normal levels after laser treatment is in average 4 weeks.…”

Section: Complications Of Laser Treatmentmentioning

confidence: 99%

Invasive Procedures in Monochorionic Twins

Antsaklis¹,

Antsaklis²

2015

Donald School Journal of Ultrasound in Obstetrics and Gynecology

View full text Add to dashboard Cite

Monochorionic twin pregnancies (MC) are less frequent but they are considered higher risk pregnancies compared to dichorionic pregnancies. As a result, determining the chorionicity of a twin pregnancy is of vital importance for the surveillance and management of the pregnancy. The problem originates from the fact that monochorionic twins have one placenta, and as a result the circulation of the two fetuses is closely related to each other mainly through anastomosis of the placenta. The number and type of anastomosis is of great importance for the course of the pregnancy. Diagnosis of chromosomal abnormalities in such pregnancies requires excellent knowledge of invasive procedures and good clinical skills. Monochorionic twins are at increased risk for unique complications including twin-to-twin transfusion syndrome (TTTS), selective intrauterine growth restriction (sIUGR), and twin-reversed arterial perfusion (TRAP) sequence. Twin-to-twin transfusion syndrome is a very well known and described complication of mono chorionic twin pregnancies and must be considered and checked in each monochorionic pregnancy. Selective feticide is not a method used very commonly in MC pregnancies, but may be applied in selected cases. For TTTS laser treatment of the anastomosis is a method of choice, but should be performed in centers with experience.

show abstract

Improved recipient survival with maternal nifedipine in twin-twin transfusion syndrome complicated by TTTS cardiomyopathy undergoing selective fetoscopic laser photocoagulation

Cited by 17 publications

References 41 publications

Multiple Pregnancies

Multiple Pregnancies

Maternal Hypotension during Fetoscopic Surgery: Incidence and Its Impact on Fetal Survival Outcomes

Invasive Procedures in Monochorionic Twins

Contact Info

Product

Resources

About