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twin to twin transfusion syndrome laser

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https://www.readbyqxmd.com/read/29122542/twin-twin-transfusion-syndrome-what-we-have-learned-from-clinical-trials
#1
REVIEW
Fatiha Djaafri, Julien Stirnemann, Imen Mediouni, Claire Colmant, Yves Ville
Monochorionic twin pregnancies are at increased risk for adverse outcome compared to dichorionic twin pregnancies and singletons. Monochorionic-specific complications include twin-twin transfusion syndrome (TTTS), twin anemia-polycythemia sequence, single intrauterine fetal demise and its consequences on the co-twin, and selective intrauterine growth restriction. Whereas the natural history of monochorionic-specific complications carries a high risk of fetal death or severe neurologic disability, a framework now exists, based on well-designed clinical trials, for optimal treatment of these entities...
November 6, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29071724/risk-factors-for-fetomaternal-bleeding-after-laser-therapy-for-twin-twin-transfusion-syndrome
#2
Andrew H Chon, Lisa M Korst, Brendan H Grubbs, Eftichia V Kontopoulos, Rubén A Quintero, Ramen H Chmait
OBJECTIVE: To quantify and assess potential risk factors for transplacental passage of fetal red blood cells (RBCs) into the maternal circulation (feto-maternal bleed, FMB) after laser surgery for twin-twin transfusion syndrome (TTTS). STUDY DESIGN: A retrospective study of Rhesus (Rh)-D negative patients that underwent laser surgery for TTTS. Patients with and without post-operative detectable fetal RBCs on Kleihauer-Betke (KB) testing were compared to determine risk factors for FMB...
October 26, 2017: Prenatal Diagnosis
https://www.readbyqxmd.com/read/29055131/case-report-of-staphylococcus-epidermidis-maternal-sepsis-and-chorioamnionitis-following-fetoscopy
#3
Gabriel Levin, Roy Zigron
A patient aged 28 years (gravida 5 para 3) who was at 21 weeks of a monochorionic diamniotic pregnancy, underwent fetoscopic laser ablation of placental blood vessels owing to stage-3 twin-to-twin transfusion syndrome (Figure 1). Ultrasonography on post-operative day 1 demonstrated marked improvement of both embryo urinary bladder filling and Doppler blood flow measurements. This article is protected by copyright. All rights reserved.
October 21, 2017: International Journal of Gynaecology and Obstetrics
https://www.readbyqxmd.com/read/29040903/aplasia-cutis-congenita-as-a-result-of-interstitial-laser-therapy-for-fetal-reduction-in-monochorionic-twins-conservative-approach-and-outcome
#4
Veronica Mugarab-Samedi, Abhay Lodha, Adel ElSharkawy, Essa Al Awad
Monochorionic (MC) twin pregnancies are known to carry a high risk of twin-to-twin transfusion syndrome (TTTS) that could lead to miscarriage and perinatal death. Demise of one fetus is frequently associated with co-fetal death. Fetal reduction by interstitial laser therapy is an effective procedure to prevent this outcome, but it may be associated with significant risks for both mother and fetus. Aplasia Cutis Congenita (ACC) may occur in up to 8% cases of fetal reduction by laser therapy. We report ACC in a preterm infant, a survivor of interstitial laser therapy for fetal reduction in MC pregnancy...
October 10, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/29027307/transient-amniotic-fluid-leakage-after-fetoscopic-laser-photocoagulation-for-twin-twin-transfusion-syndrome
#5
Shiyo Ota, Keisuke Ishii, Hiroshi Kawamura, Aki Mabuchi, Ryo Yamamoto, Shusaku Hayashi, Takeshi Kanagawa, Nobuaki Mitsuda
AIM: Iatrogenic premature rupture of membrane (PROM) is one of the major complications related to fetoscopic laser photocoagulation (FLP) for twin-twin transfusion syndrome (TTTS). However, amniotic fluid leakage (AFL) sometimes spontaneously disappears. This study evaluated the incidence and clinical characteristics of transient AFL after FLP. METHODS: We retrospectively reviewed pregnancies that underwent FLP for TTTS at a single center. Patients with apparent AFL within 2 weeks after FLP were divided into two groups: transient AFL, defined by the disappearance of fluid leakage within a week; and PROM, if AFL persisted continuously for more than a week or premature birth occurred, including miscarriage, within a week of the first symptom of AFL...
October 13, 2017: Journal of Obstetrics and Gynaecology Research
https://www.readbyqxmd.com/read/29020780/-selective-feticide-in-monochorionic-twin-pregnancies-with%C3%A2-discordant-fetal-anomalies-management-and-outcome
#6
J Vojtěch, L Hašlík, R Pock, K Běhávková, K Macková, P Hanulíková, H Heřman, L Krofta
OBJECTIVE: To analyze results and outcome after selective feticide for discordant anomalies in monochorionic twins. DESIGN: Prospective cohort study. SETTING: Fetal medicine center, Institute for the Care of Mother and Child, Praha. METHODS: Analysis of outcome of monochorionic pregnancies after intrauterine surgery for structural abnormalities between January 2013 and June 2016. RESULTS: We performed 13 intrauterine operations in monochorionic twins with structural anomalies during the period...
2017: Ceská Gynekologie
https://www.readbyqxmd.com/read/28965437/midtrimester-isolated-oligohydramnios-in-monochorionic-diamniotic-multiple-gestations
#7
Andrew H Chon, Lisa M Korst, Ryan D Assaf, Arlyn Llanes, Joseph G Ouzounian, Ramen H Chmait
OBJECTIVE: To describe the natural history and perinatal outcomes of monochorionic diamniotic twins with midtrimester isolated oligohydramnios (iOligo). MATERIALS AND METHODS: We performed a retrospective study of iOligo patients who were initially referred for the management of evolving twin-twin transfusion syndrome (TTTS) or selective intrauterine growth restriction (sIUGR). iOligo was defined as a maximum vertical pocket of amniotic fluid of ≤2 cm in the iOligo twin's sac and normal fluid level (>2 and <8 cm) in the co-twin's sac...
October 12, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28961141/neurological-complications-after-therapy-for-fetal-fetal-transfusion-syndrome-a-systematic-review-of-the-outcomes-at-24-months
#8
Ana Miralles-Gutiérrez, Isidoro Narbona-Arias, Ernesto González-Mesa
OBJECTIVE: The main objective of this study was to review the available scientific evidence about mid-term neurological outcomes in twins after laser therapy for twin-to-twin transfusion syndrome (TTTS). METHODS: A systematic review of studies on neurodevelopmental outcomes (cognition, motor development, communication skills and cerebral palsy) of twins after laser therapy for TTTS was conducted. Outcomes at 24 months of age and the use of validated scales for assessment were the selected criteria...
September 29, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/28925589/recurrent-twin-twin-transfusion-syndrome-rttts-and-twin-anemia-polycythemia-sequence-taps-after-fetoscopic-laser-surgery-fls-size-of-the-cannula-does-matter
#9
Roopali Donepudi, Joost Akkermans, Lovepreet Mann, Frans J Klumper, Johanna M Middeldorp, Enrico Lopriore, Kenneth J Moise, Michael Bebbington, Anthony Johnson, Dick Oepkes, Ramesha Papanna
OBJECTIVES: Optimal outcomes after fetoscopic laser surgery (FLS) for twin-twin transfusion (TTTS) depend on the successful completion of ablation of all placental anastomoses. Our objective was to determine the incidence and risk factors for the occurrence of recurrent TTTS (rTTTS) or twin anemia-polycythemia sequence (TAPS) after FLS, and focusing on the impact of different diameters of the cannula. METHODS: A secondary analysis of prospectively collected data of 666 consecutive patients undergoing laser surgery for TTTS from 2 centers was performed...
September 19, 2017: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28918426/aortic-isthmus-flow-recording-predicts-the-outcome-of-the-recipient-twin-after-laser-coagulation-in-twin-twin-transfusion-syndrome
#10
France Leduc, Amélie Delabaere, Roxanne Gendron, Florent Fuchs, Sandrine Wavrant, Marie-Josée Raboisson, Jean-Claude Fouron, François Audibert
INTRODUCTION: The objective was to assess the prognostic value of the systolic flow through the aortic isthmus in monochorionic pregnancies complicated by twin-twin transfusion syndrome (TTTS) treated by placental laser ablation. MATERIAL AND METHODS: Fetal echocardiography and outcome data of 105 cases of TTTS treated by laser photocoagulation of placental anastomoses were reviewed. Hemodynamic parameters were collected before and after treatment. The isthmic systolic index (ISI) was calculated as the peak systolic velocity/systolic nadir ratio...
September 16, 2017: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/28835143/neonatal-cerebral-lesions-predict-2-year-neurodevelopmental-impairment-in-children-treated-with-laser-surgery-for-twin-twin-transfusion-syndrome
#11
Ramen H Chmait, Andrew H Chon, Sheree M Schrager, Arlyn Llanes, Anita H Hamilton, Douglas L Vanderbilt
OBJECTIVE: The objective of this study is to assess whether postnatally detected cerebral abnormalities are predictive of neurodevelopmental impairment (NDI) in survivors of twin-twin transfusion syndrome (TTTS) that underwent laser surgery. MATERIALS AND METHODS: Ninety-nine children treated for TTTS had neurodevelopmental assessment at age 2-years (±6 weeks). 'High-risk survivors' had cerebral imaging in the neonatal period. 'High-risk survivors' were defined as (1) delivered at <32 weeks; or (2) cerebral imaging clinically indicated...
September 6, 2017: Journal of Maternal-fetal & Neonatal Medicine
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
#12
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
#13
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
#14
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)...
September 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
#15
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
#16
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/28585788/-intestinal-complications-in-twin-to-twin-transfusion-syndrome-ttts-treated-by-laser-coagulation-lc
#17
A Sánchez-Galán, J L Encinas, E Antolín, A Vilanova, M Dore, P Triana, J L Bartha, M López-Santamaría
AIM OF THE STUDY: The hemodynamic imbalance due to placental vascular anastomoses in TTTS but also vascular changes generated after intrauterine treatment may lead to hypoxic-ischemic complications. Different intestinal complications in TTTS are reviewed in this paper. METHODS: Retrospective review of TTTS cases treated by laser coagulation (LC) from 2012-2015. Demographic data, fetal therapy, prenatal diagnosis (US, MRI) and perinatal outcome were recorded. We describe cases with intestinal complications and their postnatal management...
January 25, 2017: Cirugía Pediátrica: Organo Oficial de la Sociedad Española de Cirugía Pediátrica
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
#18
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
#19
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/28487021/increased-risk-of-placental-abruption-after-solomon-laser-treatment-of-twin-twin-transfusion-syndrome
#20
M M Lanna, S Faiola, D Consonni, M A Rustico
To evaluate the relative risk of placental abruption in monochorionic (MC) twin pregnancies complicated with twin-to-twin transfusion syndrome (TTTS) and treated with endoscopic laser coagulation of placental vessels (ELCPV). A retrospective analysis from January 2004 and December 2015 of 373 TTTS pregnancies, treated with selective ELCPV until January 2012 (287 cases), after which the Solomon technique was introduced (86 cases), compared with 243 normal MC pregnancies. A significant improvement in perinatal survival was observed after the introduction of the Solomon technique when compared to the selective procedure (77% vs 54%, p < 0...
May 2017: Placenta
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