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A case of successful selective abortion using radio-frequency ablation in twin pregnancy suffering from severe twin to twin transfusion syndrome.

Chang EM, Park MH, Kim YJ, Kim JI, Ahn JJ, Chun SH - J. Korean Med. Sci. (2009)

Bottom Line: Perinatal mortality and morbidity is high as 80-100% if untreated and even higher if the disease is developed at early stage.Variety of methods of isolating or intercepting placental vascular anastomosis are introduced, but they are only available in centers where all the required equipments are prepared.We report here a case of TTTS complicated with severe polyhydroamnios during the second trimester.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Mokdong Ewha Medical Center, School of Medicine, Ewha Womans University, Seoul, Korea.

ABSTRACT
Twin to twin transfusion syndrome (TTTS) is one of the major complication of monochorionic twin pregnancy which is mainly understood by placental vascular anastomosis. Perinatal mortality and morbidity is high as 80-100% if untreated and even higher if the disease is developed at early stage. Variety of methods of isolating or intercepting placental vascular anastomosis are introduced, but they are only available in centers where all the required equipments are prepared. We report here a case of TTTS complicated with severe polyhydroamnios during the second trimester. The blood supply to donor twin was interrupted successfully at 19(+2) weeks of gestation by minimally invasive radio-frequency cord ablation, under ultrasound guidance. The normal recipient twin was delivered successfully at 35 weeks of gestation and had no eventful neonatal course.

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Absent blood flow in the umbilical cord of the 2nd twin after radio-frequency cord ablation.
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Figure 2: Absent blood flow in the umbilical cord of the 2nd twin after radio-frequency cord ablation.

Mentions: The method of selective abortion using RF ablation was as follows. Just before the procedure, pethidine (Demerol®) 50 mg was injected intramuscularly for emotional stability and pain killing, and prophylactic IV antibiotics was given. Betadine sterilization was done and 2% lidocaine was injected for local anesthesia. Under local anesthesia, 1 mm skin incision was done at the point where the electrode will be inserted. Under the guidance of real-time ultrasonography and color doppler, 17 gauge radio-frequency electrode was carefully inserted to the initiating portion of umbilical cord of the 2nd fetus and radio-frequency ablation was done. Intensity of radiofrequency was estimated by hypoechogenic lesion representing air bubbles which was formed as temperature of tissue rises by radiofrequency (Fig. 1). The RF intensity was increased up to 50 W. A few minutes after the procedure, cardiac arrest of the 2nd fetus was observed. Doppler flow at the cord of 2nd fetus was checked before and after the procedure (Fig. 2). The cord occlusion was successful and there was no blood flow to the 2nd fetus. Mild uterine contraction was noted after the procedure so that tocolytics (ritodrine [Yutopar®], 30 cc/hr) was infused. After the procedure, the patient's symptoms were improved and there was no other complications such as spontaneous premature rupture of membranes or vaginal bleeding. The patient was discharged 4 days after the procedure.


A case of successful selective abortion using radio-frequency ablation in twin pregnancy suffering from severe twin to twin transfusion syndrome.

Chang EM, Park MH, Kim YJ, Kim JI, Ahn JJ, Chun SH - J. Korean Med. Sci. (2009)

Absent blood flow in the umbilical cord of the 2nd twin after radio-frequency cord ablation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698202&req=5

Figure 2: Absent blood flow in the umbilical cord of the 2nd twin after radio-frequency cord ablation.
Mentions: The method of selective abortion using RF ablation was as follows. Just before the procedure, pethidine (Demerol®) 50 mg was injected intramuscularly for emotional stability and pain killing, and prophylactic IV antibiotics was given. Betadine sterilization was done and 2% lidocaine was injected for local anesthesia. Under local anesthesia, 1 mm skin incision was done at the point where the electrode will be inserted. Under the guidance of real-time ultrasonography and color doppler, 17 gauge radio-frequency electrode was carefully inserted to the initiating portion of umbilical cord of the 2nd fetus and radio-frequency ablation was done. Intensity of radiofrequency was estimated by hypoechogenic lesion representing air bubbles which was formed as temperature of tissue rises by radiofrequency (Fig. 1). The RF intensity was increased up to 50 W. A few minutes after the procedure, cardiac arrest of the 2nd fetus was observed. Doppler flow at the cord of 2nd fetus was checked before and after the procedure (Fig. 2). The cord occlusion was successful and there was no blood flow to the 2nd fetus. Mild uterine contraction was noted after the procedure so that tocolytics (ritodrine [Yutopar®], 30 cc/hr) was infused. After the procedure, the patient's symptoms were improved and there was no other complications such as spontaneous premature rupture of membranes or vaginal bleeding. The patient was discharged 4 days after the procedure.

Bottom Line: Perinatal mortality and morbidity is high as 80-100% if untreated and even higher if the disease is developed at early stage.Variety of methods of isolating or intercepting placental vascular anastomosis are introduced, but they are only available in centers where all the required equipments are prepared.We report here a case of TTTS complicated with severe polyhydroamnios during the second trimester.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Mokdong Ewha Medical Center, School of Medicine, Ewha Womans University, Seoul, Korea.

ABSTRACT
Twin to twin transfusion syndrome (TTTS) is one of the major complication of monochorionic twin pregnancy which is mainly understood by placental vascular anastomosis. Perinatal mortality and morbidity is high as 80-100% if untreated and even higher if the disease is developed at early stage. Variety of methods of isolating or intercepting placental vascular anastomosis are introduced, but they are only available in centers where all the required equipments are prepared. We report here a case of TTTS complicated with severe polyhydroamnios during the second trimester. The blood supply to donor twin was interrupted successfully at 19(+2) weeks of gestation by minimally invasive radio-frequency cord ablation, under ultrasound guidance. The normal recipient twin was delivered successfully at 35 weeks of gestation and had no eventful neonatal course.

Show MeSH
Related in: MedlinePlus