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https://www.readbyqxmd.com/read/28764674/arabin-cervical-pessary-for-prevention-of-preterm-birth-in-cases-of-twin-to-twin-transfusion-syndrome-treated-by-fetoscopic-laser-coagulation-the-pecep-laser-randomised-controlled-trial
#1
Carlota Rodó, Sílvia Arévalo, Liesbeth Lewi, Isabel Couck, Bettina Hollwitz, Kurt Hecher, Elena Carreras
BACKGROUND: Fetoscopic LASER coagulation of the placental anastomoses has changed the prognosis of twin-twin transfusion syndrome. However, the prematurity rate in this cohort remains very high. To date, strategies proposed to decrease the prematurity rate have shown inconclusive, if not unfavourable results. METHODS: This is a randomised controlled trial to investigate whether a prophylactic cervical pessary will lower the incidence of preterm delivery in cases of twin-twin transfusion syndrome requiring fetoscopic LASER coagulation...
August 1, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28736902/pseudoamniotic-band-syndrome-after-fetoscopic-laser-ablation-of-placental-anastomoses-for-twin-twin-transfusion-syndrome-two-case-reports-and-systematic-review
#2
Anne Sophie Lafitte, Eric Verspyck, Corinne Jeanne Pasquier, Patricia Dolley, Michel Dreyfus, Guillaume Benoist
Pseudoamniotic band syndrome is a rare complication that occurs after invasive procedures for complicated monochorionic twins. We report 2 cases of intrauterine recipient fetal death after laser therapy for twin-twin transfusion syndrome due to umbilical cord constriction by the amniotic band.
July 24, 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/28730318/renal-function-in-neonates-with-twin-twin-transfusion-syndrome-treated-with-or-without-fetoscopic-laser-surgery
#3
Lianne Verbeek, Faiez A Joemmanbaks, Jacoba M E Quak, Ram N Sukhai, Johanna M Middeldorp, Dick Oepkes, Enrico Lopriore
The aim of this study is to investigate the short-term renal function in neonates with twin-twin transfusion syndrome (TTTS), treated with fetoscopic laser surgery (laser group) or conservatively (non-laser group). Creatinine and urea levels and urine output were recorded in the first week after birth. Primary outcome was short-term renal dysfunction, defined as a creatinine level of >100 μmol/L during the first week postpartum. We evaluated 312 twins (laser group, n = 274; non-laser group, n = 38)...
July 20, 2017: European Journal of Pediatrics
https://www.readbyqxmd.com/read/28709445/twin-twin-transfusion-syndrome-study-protocol-for-developing-disseminating-and-implementing-a-core-outcome-set
#4
Asma Khalil, Helen Perry, James Duffy, Keith Reed, Ahmet Baschat, Jan Deprest, Kurt Hecher, Liesbeth Lewi, Enrico Lopriore, Dick Oepkes
BACKGROUND: Twin-Twin Transfusion Syndrome (TTTS) is associated with an increased risk of perinatal mortality and morbidity. Several treatment interventions have been described for TTTS, including fetoscopic laser surgery, amnioreduction, septostomy, expectant management, and pregnancy termination. Over the last decade, fetoscopic laser surgery has become the primary treatment. The literature to date reports on many different outcomes, making it difficult to compare results or combine data from individual studies, limiting the value of research to guide clinical practice...
July 14, 2017: Trials
https://www.readbyqxmd.com/read/28680967/a-continuum-robot-and-control-interface-for-surgical-assist-in-fetoscopic-interventions
#5
George Dwyer, Francois Chadebecq, Marcel Tella Amo, Christos Bergeles, Efthymios Maneas, Vijay Pawar, Emanuel Vander Poorten, Jan Deprest, Sebastien Ourselin, Paolo De Coppi, Tom Vercauteren, Danail Stoyanov
Twin-twin transfusion syndrome requires interventional treatment using a fetoscopically introduced laser to sever the shared blood supply between the fetuses. This is a delicate procedure relying on small instrumentation with limited articulation to guide the laser tip and a narrow field of view to visualize all relevant vascular connections. In this letter, we report on a mechatronic design for a comanipulated instrument that combines concentric tube actuation to a larger manipulator constrained by a remote centre of motion...
March 8, 2017: IEEE Robotics and Automation Letters
https://www.readbyqxmd.com/read/28641751/fetal-imaging-and-therapy-for-cdh-current-status
#6
Titilayo Oluyomi-Obi, Tim Van Mieghem, Greg Ryan
In congenital diaphragmatic hernia (CDH), herniation of the abdominal organs into the fetal chest causes pulmonary hypoplasia and pulmonary hypertension, the main causes of neonatal mortality. As antenatal ultrasound screening improves, the risk of postnatal death can now be better predicted, allowing for the identification of fetuses that might most benefit from a prenatal intervention. Fetoscopic tracheal occlusion is being evaluated in a large international randomized controlled trial. We present the antenatal imaging approaches that can help identify fetuses that might benefit from antenatal therapy, and review the evolution of fetal surgery for CDH to date...
June 2017: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/28617430/physician-views-regarding-the-benefits-and-burdens-of-prenatal-surgery-for-myelomeningocele
#7
R M Antiel, C A Collura, A W Flake, M P Johnson, N E Rintoul, J D Lantos, F A Curlin, J C Tilburt, S D Brown, C Feudtner
OBJECTIVE: Examine how pediatric and obstetrical subspecialists view benefits and burdens of prenatal myelomeningocele (MMC) closure. STUDY DESIGN: Mail survey of 1200 neonatologists, pediatric surgeons and maternal-fetal medicine specialists (MFMs). RESULTS: Of 1176 eligible physicians, 670 (57%) responded. Most respondents disagreed (68%, 11% strongly) that open fetal surgery places an unacceptable burden on women and their families. Most agreed (65%, 10% strongly) that denying the benefits of open maternal-fetal surgery is unfair to the future child...
June 15, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/28588850/case-report-of-myometrial-window-following-fetoscopic-treatment-of-twin-twin-transfusion-syndrome-indications-of-underlying-collagen-vascular-disease
#8
Michael V Zaretsky, David K Manchester, Henry L Galan, Nicholas J Behrendt, Ahmed I Marwan, Kenneth W Liechty, Timothy M Crombleholme
Intraperitoneal amniotic fluid leak is a known complication of fetoscopic procedures that usually resolves spontaneously with expectant management. Intraperitoneal amniotic fluid leak may persist after fetoscopic procedures due to a myometrial window as well as to persistent chorioamniotic membrane disruption, which may be amenable to surgical repair.
June 2017: Clinical Case Reports
https://www.readbyqxmd.com/read/28586146/locating-the-level-and-extent-of-congenital-high-airway-obstruction-fluid-in-the-airway-tract-as-reference-points
#9
Mamatha Gowda, Shilpa Gupta, Ashraf Ali, Shanthi Paranthaman
Described here are a series of four cases of congenital high airway obstruction in the fetus. All of the patients presented in the second trimester and all had hydrops fetalis. Three cases had bilateral hyperinflated lungs, midline shift of heart, flattening or inversion of the diaphragm, and fetal ascites. Autopsy was performed in one of these three and showed laryngeal atresia. In one fetus, there was only a unilateral huge enlargement of the lung with mediastinal shift. On autopsy, this fetus had atresia of right main bronchus...
June 6, 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/28550526/fetoscopic-patch-coverage-of-experimental-myelomenigocele-using-a-two-port-access-in-fetal-sheep
#10
Lucie Guilbaud, Nathalie Roux, Stéphanie Friszer, Charles Garabedian, Ferdinand Dhombres, Bettina Bessières, Catherine Fallet-Bianco, Federico Di Rocco, Michel Zerah, Jean-Marie Jouannic
PURPOSE: This study aims to assess the feasibility and the effectiveness of a fetoscopic myelomeningocele (MMC) coverage using a sealed inert patch through a two-port access, in the sheep model. METHODS: Forty-four fetuses underwent surgical creation of a MMC defect at day 75 and were divided into four groups according to the MMC repair technique, performed at day 90. Group 1 remained untreated. Group 2 had an open surgery using suture of the defect. Groups 3 and 4 underwent defect coverage using a Gore®-polytetrafluoroethylene patch secured with surgical adhesive (Bioglue®), with an open approach (group 3) and a fetoscopic one (group 4)...
May 26, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28549467/the-prediction-diagnosis-and-management-of-complications-in-monochorionic-twin-pregnancies-the-ommit-optimal-management-of-monochorionic-twins-study
#11
Fiona L Mackie, R Katie Morris, Mark D Kilby
BACKGROUND: Monochorionic twin pregnancies are at increased risk of complications due to sharing a single placenta and potentially developing unbalanced vascular anastomoses. Complications include twin-twin transfusion syndrome (TTTS) which affects 10-15% monochorionic twins, and if untreated has a 70-90% perinatal loss rate. We are currently unable to predict which twins will develop complications or to what severity. We have previously shown differences in angiogenic and placental growth factors in maternal blood in pregnancies complicated by TTTS compared to twin pregnancies not complicated by TTTS but matched for gestation...
May 26, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28544517/fetoscopic-laser-photocoagulation-for-amniotic-fluid-discordance-bordering-on-twin-twin-transfusion-syndrome-feasibility-perinatal-and-long-term-outcomes
#12
Katsusuke Ozawa, Rika Sugibayashi, Seiji Wada, Masahiro Sumie, Keisuke Ishii, Masahiko Nakata, Takeshi Murakoshi, Yushi Ito, Haruhiko Sago
AIM: This study investigated the feasibility and safety of fetoscopic laser photocoagulation (FLP) for amniotic fluid discordance (AFD) bordering on twin-twin transfusion syndrome (TTTS) with an absent or reverse end-diastolic velocity (AREDV) in the umbilical artery (UA), and evaluated the perinatal and long-term outcomes. METHODS: A prospective intervention study was performed between 20 + 0 and 25 + 6 weeks of gestation (UMIN000004165). AFD bordering on TTTS was defined as maximum vertical pocket (MVP) of amniotic fluid in one twin's sac ≤3 cm and amniotic fluid MVP in the other twin's sac ≥7 cm excluding TTTS...
May 19, 2017: Journal of Obstetrics and Gynaecology Research
https://www.readbyqxmd.com/read/28505609/disentanglement-of-discordant-monochorionic-monoamniotic-twins-in-a-triplet-pregnancy-an-innovative-approach-utilizing-fetoscopic-laser-coagulation-with-micro-laparoscopic-scissor-dissection
#13
https://www.readbyqxmd.com/read/28497181/new-directions-in-fetal-surgery-for-myelomeningocele
#14
Sandra K Kabagambe, Y Julia Chen, Melissa A Vanover, Payam Saadai, Diana L Farmer
The treatment of children with myelomeningocele (MMC) has improved over time, from supportive management to early postnatal closure to prenatal repair of the defect. The Management of Myelomeningocele Study (MOMS) showed that prenatal repair of MMC resulted in improved neurological outcomes compared to postnatal closure. Follow-up studies showed that prenatal repair was, as with any other fetal intervention, associated with higher rates of obstetrical complications. There was no significant difference in urological outcomes...
May 11, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28477345/fetoscopic-laser-coagulation-in-1020-pregnancies-with-twin-to-twin-transfusion-syndrome-demonstrates-improvement-of-double-survival-rates
#15
W Diehl, A Diemert, D Grasso, S Sehner, K Wegscheider, K Hecher
OBJECTIVE: To investigate the growing experience and learning curve of fetoscopic laser coagulation of the placental vascular anastomoses in severe mid trimester twin-to-twin transfusion syndrome (TTTS) and its influence on perinatal outcome in a single center setting. METHODS: Between 01/1995 and 03/2013 we performed laser therapy in 1020 consecutive pregnancies with TTTS between 15.1 and 27.4 weeks of gestation. We compared perinatal outcome in blocks of five sequential groups...
May 6, 2017: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28455084/recipient-umbilical-artery-elongation-redundancy-in-twin-twin-transfusion-syndrome
#16
Roopali Donepudi, Lovepreet K Mann, Christoph Wohlmuth, Anthony Johnson, Michael W Bebbington, Kenneth J Moise, David S Boudreaux, Helena Gardiner, Ramesha Papanna
BACKGROUND: Chronic hypertension in adults causes arterial lengthening in major arteries, but the effects of early fetal hypertension on the twin-twin transfusion syndrome recipient's vascular architecture remains unknown. OBJECTIVE: We hypothesize that arterial cord redundancy is related to recipient hypertension and subsequent heart failure. Our objectives were to: (1) establish a 3-dimensional color Doppler ultrasound method of measuring umbilical arterial length relative to its corresponding venous segment in the umbilical cord using artery vein angle; (2) compare recipient artery vein angle to gestational age-matched controls; and (3) test the association of artery vein angle with recipient heart failure...
April 25, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28453870/clinically-relevant-discordances-identified-after-tertiary-reassessment-of-fetuses-with-isolated-congenital-diaphragmatic-hernia
#17
Elisa Done, Leonardo Gucciardo, Tim Van Mieghem, Koen Devriendt, Karel Allegaert, Paul Brady, Roland Devlieger, Luc De Catte, Liesbeth Lewi, Jan Deprest
OBJECTIVE: Fetoscopic Endoluminal Tracheal Occlusion (FETO) may improve outcome of severe isolated Congenital Diaphragmatic Hernia (iCDH). We aimed to identify any discrepancy between initial assessment at the referring hospital and the evaluation at the fetal surgery center, and to document parental decisions following counseling for fetal surgery. DESIGN: Single centre retrospective study on patients with presumed iCDH either referred for assessment and counseling or referred for fetal surgery...
April 28, 2017: Prenatal Diagnosis
https://www.readbyqxmd.com/read/28434005/chorioamniotic-membrane-separation-after-fetoscopic-laser-photocoagulation
#18
Mayumi Takano, Masahiko Nakata, Susumu Murata, Masahiro Sumie, Mineto Morita
INTRODUCTION: This study aimed to investigate the risk factors, incidence, and influence on the perinatal outcome of chorioamniotic membrane separation (CMS) after fetoscopic laser photocoagulation (FLP). MATERIAL AND METHODS: This retrospective study included 312 women who underwent FLP for twin-to-twin transfusion syndrome (TTTS). Clinical records were used to review obstetrical examinations, complications, operative data, ultrasonographic findings, and perinatal and neonatal follow-up data in all patients...
April 22, 2017: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/28428904/salvage-of-necrotic-appearing-limb-after-in-utero-endoscopic-lysis-of-constriction-bands
#19
M Abdel-Sattar, A Chon, B Chen, W Burkhalter, R H Chmait
We report a case of amniotic band syndrome complicated by constriction bands and marked distal swelling of both lower extremities. Color Doppler interrogation of the right lower extremity revealed complete lack of blood flow below the level of the constriction. Upon fetoscopic survey, the right lower extremity beyond the constriction band appeared dusky red and discolored with desquamation, consistent with a necrotic appearance. The constriction bands were cut in utero using endoshears, thereby allowing restoration of blood flow on postoperative day 1...
April 2017: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/28403975/-fetoscopic-laser-coagulation-in-200%C3%A2-consecutive-monochorionic-pregnancies-with-twin-twin-transfusion-syndrome
#20
L Lecointre, N Sananès, A S Weingertner, A Gaudineau, C Akladios, V Cavillon, B Langer, R Favre
OBJECTIVES: To report preoperative data, surgical characteristics, complications and perinatal outcome of twin-twin transfusion syndrome (TTTS) managed with laser ablation surgery, to analyze predictors of neonatal survival and to compare the 100 most recent cases with the older 100. MATERIALS AND METHODS: Observational cohort moncentric study of 200 cases of TTTS consecutively treated with fetoscopic laser coagulation between January 2004 and December 2014...
February 2017: Journal of gynecology obstetrics and human reproduction
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