The outcome and prognostic factors of twin–twin transfusion syndrome following fetoscopic laser surgery

Sago, Haruhiko; Hayashi, Satoshi; Saito, Mari; Hasegawa, Hiromi; Kawamoto, Hiroshi; Kato, Naomi; Nanba, Yūsuke; Ito, Yushi; Takahashi, Yuichiro; Murotsuki, Jun; Nakata, Masahiko; Ishii, Keisuke; Murakoshi, Takeshi

doi:10.1002/pd.2647

Cited by 73 publications

(118 citation statements)

References 30 publications

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“…Table 4 presents the perinatal outcomes in published series including early series of pioneer operators [1,[17][18][19][20] and published data [12,[21][22][23][24]] from the conclusion of the Eurofetus trial comparing to the present study. Early series reported approximately a 60% overall survival rate, a 5% neurological complication rate; and a 40% survival rate of both twins.…”

Section: Resultsmentioning

confidence: 99%

The Treatments of Twin-Twin Transfusion Syndrome in Monochorionic Twin Pregnancies by the Fetoscopic Laser Photocoagulation

Murakoshi¹,

Naruse²,

Nakayama³

et al. 2013

J Health Med Inform

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Section: Resultsmentioning

confidence: 99%

The Treatments of Twin-Twin Transfusion Syndrome in Monochorionic Twin Pregnancies by the Fetoscopic Laser Photocoagulation

Murakoshi¹,

Naruse²,

Nakayama³

et al. 2013

J Health Med Inform

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“…The Quintero stage did not worsen in any of the survivors; however, stage III atypical, which was defined as abnormal Doppler flow with visible donor bladder, had a decreased survival rate especially in 2 survivors. Table 4 presents the perinatal outcomes in published series including early series of pioneer operators [1,[17][18][19][20] and published data [12,[21][22][23][24]] from the conclusion of the Eurofetus trial comparison to the present study. Early series reported approximately a 60% overall survival rate, a 5% neurological complication rate; and a 40% survival rate of both twins.…”

Section: Resultsmentioning

confidence: 99%

Fetoscopic Laser Photocoagulation for the Treatment of Twin-Twin Transfusion Syndrome in Monochorionic Twin Pregnancies

Murakoshi¹

2012

TOMDJ

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Fetoscopic laser surgery for severe twin-twin transfusion syndrome (TTTS) has become the optimal treatment choice since the release of the Eurofetus randomized clinical trial. These techniques have been adopted throughout the globe, and many institutions have instituted or will soon institute fetoscopic laser surgery procedures; however, laser surgery has a steep learning curve because of the following: challenging placental location, complex and unexpected communicating anastomoses, residual anastomoses after surgery, or discolored amniotic fluid. We have been performing laser surgery since 2002 in Japan; to date, we have compiled a series of 170 cases. Our data indicates a 78% of overall survival with 5% neonatal morbidity, 63% of survival of both twins, and 93% survival of at least one twin. The recurrent TTTS rate was 1% and the residual vessel rate was 3%.To improve the learning curve of laser surgery, the employment of various techniques is recommended to achieve a successful surgical outcome: (1) Mapping: before laser ablation, a very thorough mapping of vascular anastomoses should be done, and should be repeated after ablation; (2) Sequential order: obliteration of arterio-venous anastomoses from donor to recipient should be done first to avoid donor hypotension and/or anemia; (3) Trocar (cannula) assisted technique: Trocar assisted technique: Using gentle indent the trocar to the placenta by withdrawing the scope shortly, then anastomoses could be ablated easily; (4) Line method: to avoid residual anastomoses, the laser should draw a virtual line at the hemodynamic equator; The operator must be careful not to miss small anastomoses.These techniques can help achieve a successful outcome for fetoscopic laser surgery and improve the outcome for cases of severe TTTS.

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“…Laser therapy was undertaken for Quintero stage I to IV TTTS between 16 and 26 weeks of gestation. The laser therapy was performed as described in a previous report [15]. We excluded the some cases in which a single or double fetal death occurred after laser therapy, and recurrent cases of TTTS with polyhydramnios/oligohydramnios, because fetal death itself can lead to a decrease in hCG, and the recurrence of TTTS did not cause a decrease in hCG, as has been previously reported [9].…”

Section: Methodsmentioning

confidence: 99%

Change of maternal thyroid function in twin-twin transfusion syndrome

2015

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HUMAN CHORIONIC GONADOTROPIN (hCG) is part of the family of glycoprotein hormones, which have a common alpha-subunit and a unique beta-subunit. This family includes thyroid stimulating hormone (TSH). As a result, hCG has weak thyroid-stimulating activity [1]. In normal pregnancy, serum hCG concentrations rise soon after implantation and peak at 10 to 12 weeks of gestation, after which they decline. During the period of highest serum hCG concentrations, serum free triiodothyronine (fT3) and free thyroxine (fT4) concentrations increase, usually within the normal range, and serum TSH concentrations are correspondingly reduced. Transient subclinical hyperthyroidism occurs in 10% to 20% of normal pregnant women during the period of highest serum hCG concentrations; these women do not require treatment [2].Change of maternal thyroid function in twin-twin transfusion syndrome Masachi Hanaoka 1), 2) , Naoko Arata 2) and Haruhiko Sago Abstract. Human chorionic gonadotropin (hCG) has weak thyroid-stimulating activity because of its homology with thyroid stimulating hormone (TSH). In twin-twin transfusion syndrome (TTTS), which is a severe complication of monochorionic twin pregnancies, a close association between maternal serum hCG concentration and TTTS has been reported. And, TTTS can be treated by fetoscopic laser coagulation of the communicating vessels. To clarify the relationship between maternal serum hCG and maternal thyroid function in TTTS, the present study investigated the change in thyroid hormone and hCG levels after laser therapy. The protocol included collection of serial maternal blood samples in TTTS before laser therapy, and at two and four weeks after laser therapy. For 131 cases of TTTS, the following parameters were determined at each point: hCG, TSH, free triiodothyronine (fT3), and free thyroxine (fT4). The multiple of the median (MoM) of pre-operative hCG concentration in TTTS was 5.39 MoM (interquartile range, 2.83 -8.64). There was a moderate positive correlation between hCG and fT3 in TTTS pre-operatively (R = 0.22, P = 0.030). fT4 was also positively correlated with hCG (R = 0.33, P < 0.001). Some cases showed very high concentration in fT3. When laser therapy for TTTS was effective, the hCG concentration significantly decreased, and fT3 and fT4 decreased progressively in concert with the decrease in hCG. The relationship between hCG and thyroid function in TTTS supports the finding of TTTS as a novel etiology of hCG-mediated hyperthyroidism during pregnancy.Key words: Pregnancy, Human chorionic gonadotropin (hCG), Twin-twin transfusion syndrome (TTTS), Hyperthyroidism, Laser thearpyTwin-twin transfusion syndrome (TTTS) accounts for approximately 10% of monochorionic twin pregnancies. If left untreated, TTTS is associated with a high fetal morbidity and mortality rate [3]. A net transfusion of blood flow from one fetus (donor twin) to the other (recipient twin) via placental vascular anastomoses has been proposed as the major etiology of TTTS [4,5]. The donor twin becomes hypovolemic and oli...

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The outcome and prognostic factors of twin–twin transfusion syndrome following fetoscopic laser surgery

Abstract: FLS leads to high survival rates and low neurological morbidity for fetuses in TTTS. FLS is an effective therapeutic option for TTTS before 26 weeks of gestation. Preoperative Doppler findings of the umbilical artery and the ductus venosus are useful in predicting prognosis following FLS.

Cited by 73 publications

References 30 publications

The Treatments of Twin-Twin Transfusion Syndrome in Monochorionic Twin Pregnancies by the Fetoscopic Laser Photocoagulation

The Treatments of Twin-Twin Transfusion Syndrome in Monochorionic Twin Pregnancies by the Fetoscopic Laser Photocoagulation

Fetoscopic Laser Photocoagulation for the Treatment of Twin-Twin Transfusion Syndrome in Monochorionic Twin Pregnancies

Change of maternal thyroid function in twin-twin transfusion syndrome

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