Limits...
Selective fetoscopic laser photocoagulation of superficial placental anastomoses for the treatment of severe twin-twin transfusion syndrome.

Ruano R, Brizot Mde L, Liao AW, Zugaib M - Clinics (Sao Paulo) (2009)

Bottom Line: Prematurity was more severe in stage IV patients (p<0.01).In the case of stage III patients, the overall survival rate was 61.1%.For stage IV, as the corresponding statistics were 45.0%, 20.0% and 70.0% respectively.

View Article: PubMed Central - PubMed

Affiliation: Obstetrics Department, Universidade de São Paulo, Faculdade de Medicina da Universidade de São Paulo/SP, Brazil . rodrigoruano@hotmail.com

ABSTRACT

Objective: To report our initial institutional experience with fetoscopic laser photocoagulation of placental anastomoses in severe twin-twin transfusion syndrome using a 1.0 mm endoscope.

Methods: Between July 2006 and June 2008, 19 monochorionic diamniotic twin pregnancies complicated by severe TTTS (Quintero stages III and IV) underwent fetoscopic laser therapy. Perinatal data were prospectively collected and compared according to the Quintero stages.

Results: Nine patients were classified as stage III and ten as stage IV. The Mean gestational ages at diagnosis and procedure were 20 (range: 17-25) and 22.0 (range: 19.0-26.0) weeks, respectively, with no statistical difference between the two groups. Preterm premature rupture of the membranes occurred in two cases (10.5%), and spontaneous preterm delivery in eight (42.1%). Overall mean gestational age at delivery was 32.1 (range: 26.0-38.0) weeks. Prematurity was more severe in stage IV patients (p<0.01). Among all cases, the overall survival rate was 52.6%, and the percentages of pregnancies with survival of both babies and at least one twin were 26.3% and 78.9%, respectively. In the case of stage III patients, the overall survival rate was 61.1%. Of the stage III pregnancies, 33.3% resulted in both babies surviving, and 88.9% of these pregnancies resulted in at least one surviving twin. For stage IV, as the corresponding statistics were 45.0%, 20.0% and 70.0% respectively.

Conclusions: Our initial institutional experience with 1.0 mm fetoscopic laser therapy for severe TTTS showed results similar to those reported in the literature for larger endoscopes.

Show MeSH

Related in: MedlinePlus

(a) Fetoscopic view of superficial inter-twin vascular anastomoses in a TTTS stage III pregnancy at 22 weeks of gestation. (b,d) Fetoscopic laser photocoagulation of superficial inter-twin anastomoses.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2666485&req=5

f1-05-oa-0180: (a) Fetoscopic view of superficial inter-twin vascular anastomoses in a TTTS stage III pregnancy at 22 weeks of gestation. (b,d) Fetoscopic laser photocoagulation of superficial inter-twin anastomoses.

Mentions: Fetoscopic laser therapy of the superficial placental anastomoses was performed under local maternal anesthesia (20 ml of 1% lidocaine injected into the skin and subcutaneous tissue) followed by percutaneous insertion into the amniotic cavity of a 2.2 mm specially designed trocar with two separate work channels for a 1 mm fetoscope (11510 A, Storz, Tuttlingen, Germany) and a 0.6 mm neodymium fiber, to allow the use of yttrium-aluminum-garnet or diode laser equipment. In pregnancies with a completely anterior placenta, we used a 30° trocar of the same size and diameter. Superficial inter-twin placental anastomoses were directly identified (Figure 1a) and coagulated (Figures 1b–d). At the end of the selective laser ablation procedure, amniotic fluid was drained through the sheath after removing the fetoscope until a vertical pool of 4–6 cm was confirmed under ultrasound. Prophylactic tocolytics and antibiotics were administered perioperatively. All the patients were hospitalized for 24 to 48 hours after the procedure and were followed by weekly ultrasound examinations.


Selective fetoscopic laser photocoagulation of superficial placental anastomoses for the treatment of severe twin-twin transfusion syndrome.

Ruano R, Brizot Mde L, Liao AW, Zugaib M - Clinics (Sao Paulo) (2009)

(a) Fetoscopic view of superficial inter-twin vascular anastomoses in a TTTS stage III pregnancy at 22 weeks of gestation. (b,d) Fetoscopic laser photocoagulation of superficial inter-twin anastomoses.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2666485&req=5

f1-05-oa-0180: (a) Fetoscopic view of superficial inter-twin vascular anastomoses in a TTTS stage III pregnancy at 22 weeks of gestation. (b,d) Fetoscopic laser photocoagulation of superficial inter-twin anastomoses.
Mentions: Fetoscopic laser therapy of the superficial placental anastomoses was performed under local maternal anesthesia (20 ml of 1% lidocaine injected into the skin and subcutaneous tissue) followed by percutaneous insertion into the amniotic cavity of a 2.2 mm specially designed trocar with two separate work channels for a 1 mm fetoscope (11510 A, Storz, Tuttlingen, Germany) and a 0.6 mm neodymium fiber, to allow the use of yttrium-aluminum-garnet or diode laser equipment. In pregnancies with a completely anterior placenta, we used a 30° trocar of the same size and diameter. Superficial inter-twin placental anastomoses were directly identified (Figure 1a) and coagulated (Figures 1b–d). At the end of the selective laser ablation procedure, amniotic fluid was drained through the sheath after removing the fetoscope until a vertical pool of 4–6 cm was confirmed under ultrasound. Prophylactic tocolytics and antibiotics were administered perioperatively. All the patients were hospitalized for 24 to 48 hours after the procedure and were followed by weekly ultrasound examinations.

Bottom Line: Prematurity was more severe in stage IV patients (p<0.01).In the case of stage III patients, the overall survival rate was 61.1%.For stage IV, as the corresponding statistics were 45.0%, 20.0% and 70.0% respectively.

View Article: PubMed Central - PubMed

Affiliation: Obstetrics Department, Universidade de São Paulo, Faculdade de Medicina da Universidade de São Paulo/SP, Brazil . rodrigoruano@hotmail.com

ABSTRACT

Objective: To report our initial institutional experience with fetoscopic laser photocoagulation of placental anastomoses in severe twin-twin transfusion syndrome using a 1.0 mm endoscope.

Methods: Between July 2006 and June 2008, 19 monochorionic diamniotic twin pregnancies complicated by severe TTTS (Quintero stages III and IV) underwent fetoscopic laser therapy. Perinatal data were prospectively collected and compared according to the Quintero stages.

Results: Nine patients were classified as stage III and ten as stage IV. The Mean gestational ages at diagnosis and procedure were 20 (range: 17-25) and 22.0 (range: 19.0-26.0) weeks, respectively, with no statistical difference between the two groups. Preterm premature rupture of the membranes occurred in two cases (10.5%), and spontaneous preterm delivery in eight (42.1%). Overall mean gestational age at delivery was 32.1 (range: 26.0-38.0) weeks. Prematurity was more severe in stage IV patients (p<0.01). Among all cases, the overall survival rate was 52.6%, and the percentages of pregnancies with survival of both babies and at least one twin were 26.3% and 78.9%, respectively. In the case of stage III patients, the overall survival rate was 61.1%. Of the stage III pregnancies, 33.3% resulted in both babies surviving, and 88.9% of these pregnancies resulted in at least one surviving twin. For stage IV, as the corresponding statistics were 45.0%, 20.0% and 70.0% respectively.

Conclusions: Our initial institutional experience with 1.0 mm fetoscopic laser therapy for severe TTTS showed results similar to those reported in the literature for larger endoscopes.

Show MeSH
Related in: MedlinePlus