Incidence and impact of perioperative complications in 175 fetoscopy-guided laser coagulations of chorionic plate anastomoses in fetofetal transfusion syndrome before 26 weeks of gestation

Yamamoto, M.; Murr, Loulou El; Robyr, R.; Leleu, Fabienne; Takahashi, Yuichiro; Ville, Y.

doi:10.1016/j.ajog.2005.07.003

Cited by 154 publications

(101 citation statements)

References 4 publications

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“…Interestingly, in post-laser TAPS, it is usually the former recipient who becomes anemic, whereas the former donor becomes polycythemic (Lewi et al, 2006;Robyr et al, 2005Robyr et al, , 2006Yamamoto et al, 2005). A possible explanation could be that the colloid osmotic pressure of the ex-recipient is strongly increased prior to and shortly after laser therapy, which attracts excess fluid from the maternal blood to the recipient's fetal blood.…”

Section: Taps Versus Tttsmentioning

confidence: 99%

Twin Anemia Polycythemia Sequence: Current Views on Pathogenesis, Diagnostic Criteria, Perinatal Management, and Outcome

et al. 2016

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Monochorionic twins share a single placenta and are connected with each other through vascular anastomoses. Unbalanced inter-twin blood transfusion may lead to various complications, including twin-to-twin transfusion syndrome (TTTS) and twin anemia polycythemia sequence (TAPS). TAPS was first described less than a decade ago, and the pathogenesis of TAPS results from slow blood transfusion from donor to recipient through a few minuscule vascular anastomoses. This gradually leads to anemia in the donor and polycythemia in the recipient, in the absence of twin oligo-polyhydramnios sequence (TOPS). TAPS may occur spontaneously in 3-5% of monochorionic twins or after laser surgery for TTTS. The prevalence of post-laser TAPS varies from 2% to 16% of TTTS cases, depending on the rate of residual anastomoses. Pre-natal diagnosis of TAPS is currently based on discordant measurements of the middle cerebral artery peak systolic velocity (MCA-PSV; >1.5 multiples of the median [MoM] in donors and <1.0 in recipients). Post-natal diagnosis is based on large inter-twin hemoglobin (Hb) difference (>8 g/dL), and at least one of the following: reticulocyte count ratio >1.7 or minuscule placental anastomoses. Management includes expectant management, and intra-uterine blood transfusion (IUT) with or without partial exchange transfusion (PET) or fetoscopic laser surgery. Post-laser TAPS can be prevented by using the Solomon laser surgery technique. Short-term neonatal outcome ranges from isolated inter-twin Hb differences to severe neonatal morbidity and neonatal death. Long-term neonatal outcome in post-laser TAPS is comparable with long-term outcome after treated TTTS. This review summarizes the current knowledge after 10 years of research on the pathogenesis, diagnosis, management, and outcome in TAPS.

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Section: Taps Versus Tttsmentioning

confidence: 99%

Twin Anemia Polycythemia Sequence: Current Views on Pathogenesis, Diagnostic Criteria, Perinatal Management, and Outcome

et al. 2016

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“…In its first 5 years, the VFTS performed FLP in 49 pregnancies with severe TTTS and achieved comparable results to that of other national (Cincotta et al, 2009;Meriki et al, 2010) and international series (Hecher et al, 2000;Huber et al, 2006;Middeldorp et al, 2006;Senat et al, 2004;Yamamoto et al, 2005). Over 120 procedures have been done to date.…”

Section: The Victorian Fetal Therapy Service: Lessons From a Collabormentioning

confidence: 81%

Balancing Patient Access to Fetoscopic Laser Photocoagulation for Twin-to-Twin Transfusion Syndrome With Maintaining Procedural Competence: Are Collaborative Services Part of the Solution?

et al. 2016

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The benefits of fetoscopic laser photocoagulation (FLP) for treatment of twin-to-twin transfusion syndrome (TTTS) have been recognized for over a decade, yet access to FLP remains limited in many settings. This means at a population level, the potential benefits of FLP for TTTS are far from being fully realized. In part, this is because there are many centers where the case volume is relatively low. This creates an inevitable tension; on one hand, wanting FLP to be readily accessible to all women who may need it, yet on the other, needing to ensure that a high degree of procedural competence is maintained. Some of the solutions to these apparently competing priorities may be found in novel training solutions to achieve, and maintain, procedural proficiency, and with the increased utilization of 'competence based' assessment and credentialing frameworks. We suggest an under-utilized approach is the development of collaborative surgical services, where pooling of personnel and resources can improve timely access to surgery, improve standardized assessment and management of TTTS, minimize the impact of the surgical learning curve, and facilitate audit, education, and research. When deciding which centers should offer laser for TTTS and how we decide, we propose some solutions from a collaborative model.

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“…Según lo descrito en la literatura existen complicaciones tempranas o tardías de la terapia láser de la STFF, la cual alcanza al 20% de los casos (6). Por ello, se ha planteado que es importante realizar un seguimiento cercano de los casos tratados, no solo evaluando los parámetros biométricos, tamaño vesical y cantidad de líquido amniótico, sino que también adicionando la evaluación de la flujometría Doppler, con el objetivo de pesquisar precozmente complicaciones como una reaparición de TFF o SAP (3).…”

Section: Discussionunclassified

“…El STFF tiene una alta mortalidad, cercana al 90%, y secuelas especialmente neurológicas en los sobrevivientes (6). Inicialmente la incorporación del amniodrenaje produjo una disminución de la mortalidad, pero manteniendo secuelas neonatales relativamente altas (7).…”

Section: Introductionunclassified

Complicaciones Tardías De La Terapia Láser Como Tratamiento De La Transfusión Feto-Fetal: Caso Clínico

et al. 2011

Rev. chil. obstet. ginecol.

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RESUMENPresentamos la descripción del diagnóstico y manejo de una secuencia anemia-policitemia (SAP) que se presenta como complicación de una terapia láser exitosa en un embarazo gemelar monocorial cursando una transfusión feto-fetal (TFF) severa. Describimos la manifestación de esta complicación tardía de la terapia láser de la TFF severa y realizamos una revisión de la literatura internacional al respecto. A pesar del éxito de la introducción de la terapia láser en cuanto a la sobrevida y secuelas neonatales, recientemente se han descrito una serie de complicaciones de presentación tempranas o tardías. Entre las tardías, destacan la muerte de uno o ambos gemelos, recidiva de la TFF, y aparición de una SAP. Varios autores han descrito que la SAP sería secundaria a la presencia, o persistencia, de comunicaciones vasculares extremadamente pequeñas de flujo lento, las cuales llevan a una discordancia en los niveles de hemoglobina entre ambos gemelos, sin diferencias en sus volúmenes sanguíneos. PALABRAS CLAVE: Gemelar, transfusión feto-fetal, secuencia anemia-policitemia SUMMARYWe describe the diagnosis and management of twin anemia-polycythemia sequence (TAPS), which occurs as a late complication of successful laser therapy in twin monochorionic pregnancies developing severe twin to twin transfusion syndrome (TTTS). We offer a description of this late complication of laser therapy in this condition and a review of the related medical literature. Despite the successful introduction of laser therapy on the survival and neonatal sequelae, various early and late complications related to this procedure have been recently described. Among the late, stands out the death of one or both twins, recurrence of TTTS, and the appearance of TAPS. With regards TAPS, several authors have reported that it would be secondary to the presence, o persistence, of extremely small slow flow vascular communications, which lead to discrepancies in the hemoglobin levels between the twins, with no differences in blood volume.

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Incidence and impact of perioperative complications in 175 fetoscopy-guided laser coagulations of chorionic plate anastomoses in fetofetal transfusion syndrome before 26 weeks of gestation

Cited by 154 publications

References 4 publications

Twin Anemia Polycythemia Sequence: Current Views on Pathogenesis, Diagnostic Criteria, Perinatal Management, and Outcome

Twin Anemia Polycythemia Sequence: Current Views on Pathogenesis, Diagnostic Criteria, Perinatal Management, and Outcome

Balancing Patient Access to Fetoscopic Laser Photocoagulation for Twin-to-Twin Transfusion Syndrome With Maintaining Procedural Competence: Are Collaborative Services Part of the Solution?

Complicaciones Tardías De La Terapia Láser Como Tratamiento De La Transfusión Feto-Fetal: Caso Clínico

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