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twin to twin transfusion syndrome laser

Nicolas Sananès, Victor Gabriele, Anne Sophie Weingertner, Rodrigo Ruano, Magdalena Sanz-Cortes, Adrien Gaudineau, Bruno Langer, Israël Nisand, Chérif Youssef Akladios, Romain Favre
OBJECTIVE: The primary objective of our study was to evaluate the long-term neurodevelopment outcome after laser surgery for twin-twin transfusion syndrome (TTTS). The secondary objective was to identify perinatal prognostic factors associated with neurodevelopmental impairment. METHOD: This was a single-center cohort prospective study carried out in pregnancies complicated by TTTS and treated by laser. Neurodevleopmental assesment included the administration of Ages and Stages Questionnaires® (ASQ), for the infants between two and five years of age...
October 20, 2016: Prenatal Diagnosis
Shiraz A Maskatia, Rodrigo Ruano, Alireza A Shamshirsaz, Pouya Javadian, Joshua A Kailin, Michael A Belfort, Carolyn A Altman, Nancy A Ayres
INTRODUCTION: Twin-twin transfusion syndrome (TTTS) is the major cause for fetal demise in monochorionic diamniotic pregnancies. Estimated combined cardiac output (CCO) has not been studied in this setting. The primary aims of this study were to compare CCO in twin donor and recipient fetuses and assess differences in CCO before and after laser coagulation therapy. A secondary aim was to evaluate the relationship of CCO with perinatal mortality, defined as intrauterine or neonatal mortality (≤30 days of age) in fetuses that underwent laser coagulation therapy...
October 19, 2016: Echocardiography
Yao-Lung Chang, An-Shine Chao, Shuenn-Dyh Chang, Peter Cc Hsieh, Sheng-Yuan Su, Kuan-Ju Chen, Po-Jen Cheng, Tzu-Hao Wang
OBJECTIVE: To evaluate the outcome of twin-twin transfusion syndrome (TTTS) treated by fetoscopic laser therapy (FLT) stratified by Quintero staging. MATERIALS AND METHODS: A total of 100 TTTS cases treated by FLT, from October 2005 to August 2014, were included in this study. Cases were divided into first and second half periods to evaluate the learning effect-related outcomes, and logistic regression was applied to determine the independent factors in predicting the perinatal outcomes...
October 2016: Taiwanese Journal of Obstetrics & Gynecology
Ramen H Chmait, Eftichia V Kontopoulos, Andrew H Chon, Lisa M Korst, Arlyn Llanes, Rubén A Quintero
OBJECTIVES: Amniopatch is a proposed treatment of iatrogenic preterm premature rupture of membranes (iPPROM). We studied characteristics associated with successful amniopatch treatment of iPPROM after fetoscopic laser surgery for twin-twin transfusion syndrome. METHODS: Patients with iPPROM within 15 days of laser surgery treated with an amniopatch were studied. Factors associated with amniopatch success (i.e. cessation of leakage with normalization of amniotic fluid volume) were tested univariately and in multivariate logistic regression models...
August 10, 2016: Journal of Maternal-fetal & Neonatal Medicine
Amirhossein Moaddab, Ahmed A Nassr, Jimmy Espinoza, Rodrigo Ruano, Zhoobin H Bateni, Amir A Shamshirsaz, George T Mandy, Stephen E Welty, Hadi Erfani, Edwina J Popek, Michael A Belfort, Alireza A Shamshirsaz
Twin anemia polycythemia sequence (TAPS) is defined by significant intertwin hemoglobin discordance without the amniotic fluid discordance that characterizes twin-twin-transfusion syndrome (TTTS) in monochorionic twin pregnancies. TAPS is an uncommon condition which can either occur spontaneously, or following fetoscopic laser ablation for TTTS. This complication is thought to result from chronic transfusion through very small placental anastomoses; however, the pathogenesis of TAPS remains unknown. Consequently, there is no consensus in the management of TAPS...
October 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Masahiko Nakata, Keisuke Ishii, Masahiro Sumie, Mayumi Takano, Hiroko Hirata, Susumu Murata, Yuichiro Takahashi, Takeshi Murakoshi, Haruhiko Sago
OBJECTIVE: The aim of this study is to clarify the feasibility and efficacy of fetoscopic laser photocoagulation of placental vascular communicating vessels (FLP) on twin-twin transfusion syndrome (TTTS) after 26 weeks of gestation. MATERIALS AND METHODS: This is a prospective pilot study investigating all cases of TTTS between 26 weeks and 27 weeks during 2012 and 2013 in Japan. The primary endpoints in this study were the feasibility of FLP and rate of harmful complications for the mother's health...
August 2016: Taiwanese Journal of Obstetrics & Gynecology
Javier U Ortiz, Narcís Masoller, Olga Gómez, Mar Bennasar, Elisenda Eixarch, Silvia M Lobmaier, Fàtima Crispi, Eduard Gratacos, Josep María Martinez
OBJECTIVE: To evaluate the rate of pulmonary stenosis and functional pulmonary atresia (PS/PA) in recipient twins prior to fetal surgery for twin-twin transfusion syndrome (TTTS) and their pre- and postnatal outcomes. METHODS: We carried out a prospective study including 260 cases of TTTS. Echocardiography was performed before laser surgery to detect the presence of PS/PA. The outcomes of recipients with and without PS/PA were compared. The need of postnatal cardiac interventions and the survival rate at 6 months of age were also evaluated...
July 26, 2016: Fetal Diagnosis and Therapy
Warwick B Dunn, J William Allwood, Tim Van Mieghem, R Katie Morris, Fiona L Mackie, Caroline E Fox, Mark D Kilby
INTRODUCTION: Twin-twin transfusion syndrome (TTTS) complicates 15% of monochorionic twin pregnancies, often being associated with recipient cardiac dysfunction. Untreated, it has a fetal mortality rate of at least 90%; although treatment by fetoscopic laser coagulation significantly improves prognosis. Measurement of recipient amniotic fluid metabolites, such as cardiac Troponin T and atrial natriuretic polypeptide, correlate with cardiac function in this fetus. The aim of this study is to describe the amniotic fluid metabolomic profile in TTTS, relate this to fetal recipient cardiac function and assess the metabolomic changes induced by fetoscopic laser coagulation...
August 2016: Placenta
Arundhati Gosavi, Pradip D Vijayakumar, Bryan Sw Ng, May-Han Loh, Lay Geok Tan, Nuryanti Johana, Yi Wan Tan, Dedy Sandikin, Lin Lin Su, Tuangsit Wataganara, Arijit Biswas, Mahesh A Choolani, Citra Nz Mattar
INTRODUCTION: Management of complicated monochorionic twins and certain intrauterine structural anomalies is a pressing challenge in communities still lacking advanced fetal therapy. We describe our efforts to rapidly initiate selective feticide using radiofrequency ablation (RFA) and selective fetoscopic laser photocoagulation (SFLP) for twin-twin transfusion syndrome (TTTS) and present the latter as a potential model for aspiring fetal therapy units. METHODS: Five pregnancies with fetal complications were identified for RFA...
July 21, 2016: Singapore Medical Journal
Depeng Zhao, Danielle Cohen, Johanna M Middeldorp, Erik W van Zwet, Monique E De Paepe, Dick Oepkes, Enrico Lopriore
OBJECTIVE: To estimate the incidence of histologic chorioamnionitis and funisitis after fetoscopic laser surgery for the management of twin-twin transfusion syndrome. METHODS: A case-control study was performed at the Leiden University Medical Center from 2013 to 2014. All patients with twin-twin transfusion syndrome managed with laser surgery during the study period were included and compared with a control group of all monochorionic twins not treated with laser surgery...
August 2016: Obstetrics and Gynecology
S J Eschbach, L S T M Boons, E van Zwet, J M Middeldorp, F J C M Klumper, E Lopriore, A K K Teunissen, M E Rijlaarsdam, D Oepkes, A D J Ten Harkel, M C Haak
OBJECTIVE: Severe right Ventricular Outflow Tract Obstruction (RVOTO) is a complication in recipient twins in Twin-to-Twin-Transfusion Syndrome (TTTS), which requires post-partum follow-up or treatment. The objective of our study was to evaluate pregnancy characteristics of neonates with RVOTO in complicated monochorionic twin pregnancies. In the TTTS cases we aimed to determine the incidence and to construct a prediction model for the development of RVOTO. METHODS: An observational cohort study of all complicated monochorionic twin pregnancies with a post-partum neonatal diagnosis of RVOTO was performed...
July 1, 2016: Ultrasound in Obstetrics & Gynecology
J Stirnemann, G Chalouhi, M Essaoui, N Bahi-Buisson, P Sonigo, A-E Millischer, A Lapillonne, V Guigue, L J Salomon, Y Ville
OBJECTIVE: To describe the incidence and nature of prenatal brain damage following fetoscopic laser selective coagulation (FLSC) of placental vessels for twin-to-twin transfusion syndrome (TTTS). DESIGN: Retrospective observational study. SETTING: Single center cohort. POPULATION: All consecutive cases referred for TTTS treated by FLSC between 2003 and 2015. METHODS: After the FLSC, patients were followed weekly by ultrasound...
June 27, 2016: BJOG: An International Journal of Obstetrics and Gynaecology
Amol Malshe, Saul Snowise, Lovepreet K Mann, Noemi Boring, Anthony Johnson, Michael W Bebbington, Kenneth J Moise, Ramesha Papanna
BACKGROUND: Preterm delivery after fetoscopic laser surgery (FLS) for twin-twin transfusion syndrome (TTTS) remains a major challenge. The causative factors leading to preterm delivery continue to be elusive and better understanding of the risk factors could reduce complications. The objectives of this study was to determine the etiology for preterm delivery after FLS for TTTS and its associated risk factors. METHODS: This is a secondary analysis of a prospective study of 203 patients with TTTS who underwent FLS at a single center...
May 25, 2016: Ultrasound in Obstetrics & Gynecology
Femke Slaghekke, Dick Oepkes
Monochorionic twin pregnancies can be complicated by twin-to-twin transfusion syndrome (TTTS). The best treatment option for TTTS is fetoscopic laser coagulation of the vascular anastomoses between donor and recipient. After laser therapy, up to 33% residual anastomoses were seen. These residual anastomoses can cause twin anemia polycythemia sequence (TAPS) and recurrent TTTS. In order to reduce the number of residual anastomoses and their complications, a new technique, the Solomon technique, where the whole vascular equator will be coagulated, was introduced...
June 2016: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
Rubén A Quintero, Eftichia Kontopoulos, Ramen H Chmait
OBJECTIVE: Laser ablation of all placental vascular anastomoses is the optimal treatment for twin-twin transfusion syndrome (TTTS). However, two important controversies are apparent in the literature: (a) a gap between concept and performance, and (b) controversy regarding whether all the anastomoses can be identified endoscopically and whether blind lasering of healthy placenta is justified. The purpose of this article is: (a) to address the potential source of the gap between concept and performance by analyzing the fundamental steps needed to successfully accomplish the surgery, and (b) to discuss the resulting competency benchmarks reported with the different surgical techniques...
June 2016: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
Chelsea L Glennon, Scott A Shemer, Ricardo Palma-Dias, Mark P Umstad
Historical suggestions of twin-to-twin transfusion syndrome (TTTS) date back to the early 17th century. Placental anastomoses were first reported in 1687; however, it was Schatz who first identified their importance in 1875. He recognized 'the area of transfusion' within the 'villous district' of the placenta, which he named the 'third circulation'. This article describes how the management of TTTS has evolved as we have gained a more sophisticated understanding and appreciation of the complex vascular anastomoses that exist in monochorionic twin placentae...
June 2016: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
Saul Snowise, Lovepreet K Mann, Kenneth J Moise, Anthony Johnson, Michael W Bebbington, Ramesha Papanna
OBJECTIVE: To assess the incidence, clinical course, risk factors and outcomes of preterm premature rupture of membranes (PPROM) after fetoscopic laser photocoagulation (FLP). STUDY DESIGN: This was a prospective observational cohort study of 154 consecutive twin-twin transfusion syndrome (TTTS) cases. PPROM was defined as rupture of membranes ≤34 weeks gestation. Procedure-to-PPROM and PPROM-to-delivery intervals were both determined. Relevant preoperative and intra-operative variables were analyzed by univariate and multivariate logistic regression to determine their impact on PPROM after FLP...
May 6, 2016: Ultrasound in Obstetrics & Gynecology
Matthew M Finneran, Ryan Pickens, Megan Templin, Courtney D Stephenson
OBJECTIVE: To validate the efficacy of laser therapy for TTTS in the treatment of recipient twin cardiomyopathy and investigate if severity of preoperative cardiomyopathy can predict fetal survival postoperatively. STUDY DESIGN: Retrospective study of MCDA pregnancies complicated by TTTS treated by selective fetoscopic laser photocoagulation (SFLP) performed between March 2010 and October 2014 at a single center. The recipient right ventricular (RV) and left ventricular (LV) MPI were measured both pre and postoperatively...
May 6, 2016: Journal of Maternal-fetal & Neonatal Medicine
Asma Khalil, Emily Cooper, Rosemary Townsend, Basky Thilaganathan
OBJECTIVES: The natural history of stage 1 Twin-to-twin transfusion syndrome (TTTS) remains unclear and its optimal management is yet to be established. The main aims of this meta-analysis were to quantify the incidence of progression in stage 1 TTTS and to ascertain survival in these pregnancies. METHODS: MEDLINE, EMBASE, and The Cochrane Library were searched. Reference lists within each article were hand-searched for additional reports. The outcomes included incidence of progression and survival in stage 1 TTTS...
June 2016: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
Liselotte E M van Kempen, Depeng Zhao, Sylke J Steggerda, Vincent Bekker, Johanna M Middeldorp, Dick Oepkes, Enrico Lopriore
OBJECTIVE: To investigate the occurrence of early-onset neonatal sepsis (EOS) in twin-twin transfusion syndrome (TTTS) managed with laser surgery. STUDY DESIGN: We performed a prospective cohort study of all consecutive TTTS cases treated with laser surgery (TTTS group) delivered at the Leiden University Medical Center. We recorded the occurrence of EOS, defined as a positive blood culture ≤72 hours postpartum (proven sepsis) or administration of a full course of antibiotics due to risk factors or signs of sepsis, in the absence of a positive blood culture (suspected sepsis)...
June 2016: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
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