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twin to twin transfusion syndrome laser

Mert Ozan Bahtiyar, Emre Ekmekci, Emine Demirel, Roxanna A Irani, Joshua A Copel
Monochorionic twin pregnancies are at risk of unique complications due to placental sharing and vascular connections between placental territories assigned for each twin. Twin anemia-polycythemia sequence (TAPS) is an infrequent but potentially dangerous complication of abnormal placental vascular connections. TAPS occurs due to very-small-caliber (< 1 mm) abnormal placental vascular connections which lead to chronic anemia in the donor twin and polycythemia in the recipient twin. TAPS may occur spontaneously or following fetoscopic laser photocoagulation of communicating placental vessels for twin-twin transfusion syndrome...
March 13, 2018: Fetal Diagnosis and Therapy
Marcel Tella-Amo, Loic Peter, Dzhoshkun I Shakir, Jan Deprest, Danail Stoyanov, Juan Eugenio Iglesias, Tom Vercauteren, Sebastien Ourselin
The most effective treatment for twin-to-twin transfusion syndrome is laser photocoagulation of the shared vascular anastomoses in the placenta. Vascular connections are extremely challenging to locate due to their caliber and the reduced field-of-view of the fetoscope. Therefore, mosaicking techniques are beneficial to expand the scene, facilitate navigation, and allow vessel photocoagulation decision-making. Local vision-based mosaicking algorithms inherently drift over time due to the use of pairwise transformations...
April 2018: Journal of Medical Imaging
Nicola Persico, Francesco D'Ambrosi, Isabella Fabietti, Simona Boito, Elisa Aiello, Alessandro Bulfoni, Fabrizio Ciralli, Alessandra Kustermann, Fabio Mosca, Luigi Fedele
OBJECTIVE: To investigate sequential Doppler changes in donors and recipients before and one week after endoscopic laser for twin-to-twin transfusion syndrome (TTTS) and to examine factors that may be associated with such changes. METHODS: In TTTS pregnancies undergoing laser treatment, we examined fetal Doppler changes before and one week post-intervention. Intrauterine death rates and preoperative factors were analysed in relation to Doppler changes. RESULTS: Among 129 (85...
February 13, 2018: Prenatal Diagnosis
Haruhiko Sago, Keisuke Ishii, Rika Sugibayashi, Katsusuke Ozawa, Masahiro Sumie, Seiji Wada
The aim of this study was to review fetoscopic laser photocoagulation (FLP), which ablates placental vascular anastomoses to treat twin-twin transfusion syndrome (TTTS). A review of studies reporting on the procedures, outcomes, complications and nonconventional applications of FLP for TTTS was conducted. FLP has been established as the primary treatment for monochorionic twin pregnancy associated with TTTS at 16-26 weeks. FLP is the only therapy that directly addresses the underlying pathophysiology. The recent technique modification of FLP, referred to as the 'Solomon technique', induces selective coagulation to connect the anastomoses ablation sites and has been introduced to reduce residual anastomoses...
February 13, 2018: Journal of Obstetrics and Gynaecology Research
Maela Le Lous, Imen Mediouni, Gihad Chalouhi, Laurent Salomon, Laurence Bussières, Aude Carrier, Jean-Pierre Bernard, Yves Ville
OBJECTIVES: The objective of our study was to determine the impact of laser therapy for twin-to-twin transfusion syndrome (TTTs) on subsequent pregnancies. METHODS: This was a monocentric retrospective observational study. Women treated by laser fetoscopy for TTTs were asked to answer a postal questionnaire about subsequent pregnancies. The primary outcome was fecundity (number of pregnancies and time to pregnancy). We also assessed pregnancy complications, birth weight, and gestational age at delivery...
February 8, 2018: Prenatal Diagnosis
J Stirnemann, F Djaafri, A Kim, I Mediouni, L Bussieres, E Spaggiari, C Veluppillai, A Lapillonne, E Kermorvant, J-F Magny, C Colmant, Y Ville
OBJECTIVE: Preterm premature rupture of membranes (PPROM) is a leading complication following fetoscopic laser coagulation (FLC) for twin-twin transfusion syndrome (TTTS). Our primary objective was to describe the impact of improvements in surgical technique on survival and rate of PPROM over time. The secondary objective was to assess potential risk factors for PPROM. DESIGN AND SETTING: Single center retrospective observational study. POPULATION: 1092 consecutive cases of TTTS operated by FLC, between 2000 and 2016, with a 6...
January 30, 2018: BJOG: An International Journal of Obstetrics and Gynaecology
Myrna S Aboudiab, Andrew H Chon, Lisa M Korst, Arlyn Llanes, Joseph G Ouzounian, Ramen H Chmait
The objective of this study was to describe the management and perinatal outcomes of patients with twin-twin transfusion syndrome (TTTS) and an extremely short cervical length (CL). This retrospective study examined 17 patients with TTTS and a preoperative CL ≤1.0 cm who had undergone laser surgery and perioperative cervical cerclage placement successfully. In this subset of patients, the median interval between surgery and delivery was 9.6 (range 2.1-13.9) weeks and only one patient had PPROM within 3 weeks of surgery...
January 27, 2018: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
Javier U Ortiz, Ximena Torres, Elisenda Eixarch, Mar Bennasar, Monica Cruz-Lemini, Olga Gómez, Silvia M Lobmaier, Josep M Martínez, Eduard Gratacós, Fatima Crispi
OBJECTIVE: To evaluate left myocardial performance index (MPI) and time intervals in fetuses with twin-to-twin transfusion syndrome (TTTS) before and after laser surgery. METHODS: Fifty-one fetal pairs with TTTS and 47 uncomplicated monochorionic twin pairs were included. Left ventricular isovolumetric contraction time (ICT), ejection time (ET), and isovolumetric relaxation time (IRT) were measured using conventional Doppler. RESULTS: Recipients showed prolonged ICT (46 ± 12 vs...
January 19, 2018: Fetal Diagnosis and Therapy
Simen Vergote, Liesbeth Lewi, Willem Gheysen, Luc de Catte, Roland Devlieger, Jan Deprest
BACKGROUND: An improved survival and quality of life for neonatal survivors after fetoscopic laser therapy (FLC) for twin-twin transfusion syndrome (TTTS) has been reported. However, little is known about the medium-term maternal effects after FLC with respect to reproductive and gynecologic outcomes. OBJECTIVE: To document reproductive, obstetric, gynecologic and psychological outcomes in women who underwent FLC for TTTS. STUDY DESIGN: Monocentric controlled study on consecutive women who underwent FLC for TTTS between 2007 and 2013 at the University Hospitals Leuven (cases; n=198)...
January 12, 2018: American Journal of Obstetrics and Gynecology
P J C Knijnenburg, F Slaghekke, L S A Tollenaar, J M van Klink, D P Zhao, J M Middeldorp, M C Haak, F J Klumper, D Oepkes, E Lopriore
OBJECTIVES: To evaluate the incidence of residual anastomoses (RA) after laser therapy for twin-twin transfusion syndrome (TTS) and investigate risk factors for incomplete laser surgery. MATERIAL AND METHODS: All available TTS placentas treated with laser at our center between 2002 and 2016 were injected with color dye to assess the presence of RA. We evaluated the incidence of RA over the past 15 years by dividing the cohort into three time periods, and studied the association with risk factors and neonatal outcome...
January 12, 2018: Fetal Diagnosis and Therapy
Ramen H Chmait, Andrew H Chon, Lisa M Korst, Arlyn Llanes, Eftichia V Kontopoulos, Ruben A Quintero
OBJECTIVE:  The objective of this study was to assess whether the location of the trocar insertion site for laser treatment of twin-twin transfusion syndrome was associated with preterm-premature rupture of membranes (PPROM) and preterm birth (PTB). STUDY DESIGN:  In this study trocar location was documented in the operating room. Lower uterine segment (LUS) location was defined as any insertion <10 cm vertically from the pubic symphysis. Lateral location was defined as ≥5 cm horizontally from the midline...
January 10, 2018: American Journal of Perinatology
Andrew H Chon, Mary Rose Mamey, Sheree M Schrager, Douglas L Vanderbilt, Ramen H Chmait
OBJECTIVE: To determine the relationship between preoperative fetal head circumference (HC) and cognitive performance among children treated with laser surgery for twin-twin transfusion syndrome (TTTS). METHODS: Donor and recipient twin HCs were measured preoperatively (16-26 weeks' gestation) and at 2 years corrected age. Multilevel multivariate regression models were used to test pregnancy and child-level risk factors for lower Battelle Developmental Inventory Second Edition (BDI-2) scores...
January 4, 2018: Prenatal Diagnosis
Brian J Gordon, Andrew H Chon, Lisa M Korst, Arlyn Llanes, David A Miller, Ramen H Chmait
INTRODUCTION: Incidental septostomy, or inadvertent perforation of the twins' dividing membranes, can create a functional monoamniotic twin pregnancy. Our aim was to describe the perinatal outcomes and antenatal management of patients with incidental septostomy after laser surgery for twin-twin transfusion syndrome (TTTS). MATERIALS AND METHODS: Monochorionic diamniotic multiple gestations with a gestational age (GA) between 16 and 26 weeks that underwent laser surgery from March 2006 to December 2015 were studied retrospectively...
December 5, 2017: Fetal Diagnosis and Therapy
Matthew M Finneran, Megan A Templin, Courtney D Stephenson
OBJECTIVE: To investigate the natural course of abnormal umbilical artery Doppler (UAD) findings in donor fetuses after laser surgery and the prognostic significance of resolution, persistence, or new onset UAD abnormalities with and without the presence of preoperative growth discordance. STUDY DESIGN: Retrospective cohort study of all monochorionic-diamniotic multi-fetal gestations diagnosed with twin-twin transfusion syndrome (TTTS) undergoing laser surgery at a single large metropolitan referral center from 2010-2016...
November 27, 2017: Journal of Maternal-fetal & Neonatal Medicine
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...
December 2017: Seminars in Fetal & Neonatal Medicine
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 (fetomaternal bleeding, FMB) after laser surgery for twin-twin transfusion syndrome (TTTS). STUDY DESIGN: A retrospective study of Rhesus-D negative patients that underwent laser surgery for TTTS. Patients with and without postoperative detectable fetal RBCs on Kleihauer-Betke (KB) testing were compared to determine risk factors for FMB...
December 2017: Prenatal Diagnosis
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
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
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
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
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