Laser surgery in twin–twin transfusion syndrome with proximate cord insertions

Zhao, Depeng; Peeters, Suzanne; Middeldorp, Johanna M.; Klumper, Frans; Oepkes, Dick; Lopriore, Enrico

doi:10.1016/j.placenta.2013.10.004

Cited by 17 publications

(20 citation statements)

References 13 publications

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“…The majority of TTTS cases examined at our center are treated with fetoscopic laser surgery and these cases were excluded from this study. In a previous study in TTTS cases managed with fetoscopic laser surgery at our center, we reported a 2% (4/252) rate of PCI [9], which is in accordance with the rate of PCI in TTTS cases managed conservatively in this study.…”

Section: Discussionsupporting

confidence: 91%

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Monochorionic placentas with proximate umbilical cord insertions: Definition, prevalence and angio-architecture

et al. 2015

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Section: Discussionsupporting

confidence: 91%

“…Accordingly, the cut-off value for PCI ranged from 3.3 to 4.0 cm across gestation. This cut-off value is slightly lower than the 5 cm cut-off used in previous studies [7,17]. However, the 5 cm cut-off value was based on arbitrary assumptions and not derived from scientific analysis.…”

Section: Discussionmentioning

confidence: 79%

Monochorionic placentas with proximate umbilical cord insertions: Definition, prevalence and angio-architecture

et al. 2015

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“…Zhao et al [6] documented that the prevalence of CIs in close proximity was 2% in 252 cases with TTTS treated with FLP; in cases with CIs in close proximity, residual vascular anastomoses were detectable in all placentas. Conversely, perinatal mortality rates were similar, despite the presence or absence of CIs in close proximity.…”

Section: Discussionmentioning

confidence: 99%

Twin-Twin Transfusion Syndrome in Cases with Suspected Close Proximity of Umbilical Cord Insertions

Sato¹,

Ishii²,

Yonetani³

et al. 2015

Fetal Diagn Ther

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We encountered 3 cases of twin-twin transfusion syndrome (TTTS), in which preoperative ultrasonography revealed that the cord insertion sites of the twins were close. Two cases were successfully treated with fetoscopic laser photocoagulation (FLP); however, the third case could not be treated surgically because fetoscopy revealed that the cord insertions formed a V-shaped joint above the placenta and that all chorionic vessels of the placental surface were shared by the twins. No residual anastomoses were detected on placental examination in the 2 cases treated with FLP. Our experiences indicate that the feasibility of FLP could be evaluated using fetoscopy, not just ultrasonography, in cases of TTTS accompanied by proximate umbilical cord insertion.

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“…Fetoscopic laser photocoagulation has been recognized as a preferred treatment for TTTS, because it can markedly improve fetal outcomes [8,9] . The optimal timing of fetoscopic laser photocoagulation for treatment of TTTS is between 16 and 26 gestational weeks [10,11] .…”

Section: Discussionmentioning

confidence: 99%

Influences of Different Doses of Midazolam on Mother and Fetus in Fetoscopic Surgery for Twin-to-Twin Transfusion Syndrome

Han

Tian

et al. 2015

Pharmacology

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Objective: We observed influences of different doses of intravenous midazolam on mother and fetus in fetoscopic surgery for twin-to-twin transfusion syndrome (TTTS). Methods: A total of 18 pregnant women with TTTS were randomly divided into groups M1 and M2 according to differing doses of midazolam. Some parameters were respectively recorded as prior to administration of midazolam (T0), instantly after anesthesia induction (T1), at incision (T2), instantly after laser coagulation (T3) and at the end of surgery (T4). Results: There was no statistical difference in oxygen saturation and respiratory rate between groups M1 and M2 (all p > 0.05); but mean arterial pressure, heart rate, anxiety visual analog test, Observer's Assessment of Alertness/Sedation scale values and Kreb's scores were significantly lower in group M2 than in group M1 from T1 to T4 (all p < 0.05). In both groups, there was no fetal movement during laser coagulation. Conclusion: We propose that the appropriate dose for midazolam be 0.02 mg/kg in fetoscopic surgery for TTTS.

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Laser surgery in twin–twin transfusion syndrome with proximate cord insertions

Cited by 17 publications

References 13 publications

Monochorionic placentas with proximate umbilical cord insertions: Definition, prevalence and angio-architecture

Monochorionic placentas with proximate umbilical cord insertions: Definition, prevalence and angio-architecture

Twin-Twin Transfusion Syndrome in Cases with Suspected Close Proximity of Umbilical Cord Insertions

Influences of Different Doses of Midazolam on Mother and Fetus in Fetoscopic Surgery for Twin-to-Twin Transfusion Syndrome

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