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twin to twin transfusion syndrome laser

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https://www.readbyqxmd.com/read/29740835/factors-associated-to-early-intrauterine-fetal-demise-after-laser-for-ttts-by-pre-operative-fetal-heart-and-doppler-ultrasound
#1
Amélie Delabaere, France Leduc, Quentin Reboul, Florent Fuchs, Sandrine Wavrant, Johanne Dubé, Jean-Claude Fouron, François Audibert
OBJECTIVE: To determine the prognostic value of fetal Doppler and echocardiographic parameters for intra-uterine fetal demise (IUFD) within 24 hours and within one week after laser coagulation in monochorionic pregnancies complicated by twin-twin transfusion syndrome (TTTS). METHOD: This retrospective study correlated the preoperative hemodynamic and echocardiography parameters to the outcome in fetuses with TTTS undergoing laser therapy. RESULTS: One hundred and twelve laser coagulations were performed between February 2006 and June 2015...
May 9, 2018: Prenatal Diagnosis
https://www.readbyqxmd.com/read/29698746/for-submission-to-the-journal-of-gynaecology-obstetrics-and-human-reproduction
#2
Mélanie Korsakissok, Marion Groussolles, Odile Dicky, Corinne Alberge, Charlotte Casper, Corinne Azogui-Assouline
OBJECTIVE: To describe the morbidity and mortality and long-term neurodevelopmental outcomes in children born from a Twin-to-Twin Transfusion Syndrome (TTTS) pregnancy treated using laser fetoscopy in Toulouse. POPULATION AND METHOD: All pregnancies with TTTS treated by laser fetoscopy in our centre were included. Antenatal and postnatal morbidity and neonatal morbidity were identified in the medical records retrospectively. The neurodevelopmental outcome was studied using Ages and Stages Questionnaires (ASQ) sent to the parents, an oral interview with the parents and with the child's doctor (last objective neurological examination, rehabilitation needs, learning disabilities)...
April 23, 2018: Journal of Gynecology Obstetrics and Human Reproduction
https://www.readbyqxmd.com/read/29630059/model-surgical-training-skills-acquisition-in-fetoscopic-laser-photocoagulation-of-monochorionic-diamniotic-twin-placenta-using-realistic-simulators
#3
Tuangsit Wataganara, Arundhati Gosavi, Katika Nawapun, Pradip D Vijayakumar, Nisarat Phithakwatchara, Mahesh Choolani, Lin Lin Su, Arijit Biswas, Citra N Z Mattar
Fetoscopic laser coagulation of arterio-venous anastomoses (AVA) in a monochorionic placenta is the standard of care for twin-twin transfusion syndrome (TTTS), but is technically challenging and can lead to significant complications. Acquiring and maintaining the necessary surgical skills require consistent practice, a critical caseload, and time. Training on realistic surgical simulators can potentially shorten this steep learning curve and enables several proceduralists to acquire procedure-specific skills simultaneously...
March 21, 2018: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/29582948/-advances-in-fetal-therapy-in-complicated-monochorionic-pregnancies-and-in-severe-congenital-diaphragmatic-hernia-five-years-experience
#4
Yuval Gielchinsky, Dan V Valsky, Nili Yanai, Firas J Abdeljawad, Mazen A Muhaisen, Dan Arbell, Yehuda Ginosar, Orna Ben-Yosef, Orite Winograd, Benjamin Bar-Oz, Simcha Yagel, Smadar Eventov-Friedman
INTRODUCTION: : Minimally invasive fetal therapeutic procedures reduce the morbidity and mortality in monochorionic (MC) twins and in fetuses with congenital diaphragmatic hernia (CDH). MC pregnancies share their blood systems due to communicating vessels over their single placenta and may develop specific complications: Twin-to-Twin transfusion syndrome (TTTS), Selective intrauterine growth restriction (sIUGR), Twin Anemia-Polycythemia Sequence (TAPS), Twin Reverse Arterial Perfusion Syndrome (TRAP) or anomalies in one...
March 2018: Harefuah
https://www.readbyqxmd.com/read/29573746/effects-of-inter-twin-vascular-anastomoses-of-monochorionic-twins-with-selective-intrauterine-growth-restriction-on-the-contents-of-placental-mitochondria-dna
#5
Yao-Lung Chang, An-Shine Chao, Hsiu-Huei Peng, Shuenn-Dyh Chang, Sheng-Yuan Su, Kuan-Ju Chen, Tzu-Hao Wang
BACKGROUND: Placental mitochondrial DNA (mtDNA) has been proposed to be an indicator for placental hypoxia. This study was designed to evaluate the effect of vascular anastomoses between monochorionic (MC) twins on placental mtDNA. METHODS: In this study, twin-twin transfusion syndrome (TTTS) treated with laser therapy and MC twins without TTTS (without laser therapy) resulting in two live babies were included in this study. The placental mtDNA fold changes (FC) between the small and large twins were analyzed using real-time quantitative PCR...
March 24, 2018: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29533957/in-utero-partial-exchange-transfusion-combined-with-in-utero-blood-transfusion-for-prenatal-management-of-twin-anemia-polycythemia-sequence
#6
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
https://www.readbyqxmd.com/read/29487889/probabilistic-visual-and-electromagnetic-data-fusion-for-robust-drift-free-sequential-mosaicking-application-to-fetoscopy
#7
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
https://www.readbyqxmd.com/read/29436718/fetal-doppler-changes-1-week-after-endoscopic-equatorial-laser-for-twin-to-twin-transfusion-syndrome-a-longitudinal-study
#8
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 1 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 1 week postintervention. Intrauterine death rates and preoperative factors were analyzed in relation to Doppler changes. RESULTS: Among 129 (85...
April 2018: Prenatal Diagnosis
https://www.readbyqxmd.com/read/29436080/fetoscopic-laser-photocoagulation-for-twin-twin-transfusion-syndrome
#9
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
https://www.readbyqxmd.com/read/29417606/impact-of-laser-therapy-for-twin-to-twin-transfusion-syndrome-on-subsequent-pregnancy
#10
Maela Le Lous, Imen Mediouni, Gihad Chalouhi, Laurent J 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...
March 2018: Prenatal Diagnosis
https://www.readbyqxmd.com/read/29380497/preterm-premature-rupture-of-membranes-is-a-collateral-effect-of-improvement-in-perinatal-outcomes-following-fetoscopic-coagulation-of-chorionic-vessels-for-twin-twin-transfusion-syndrome-a-retrospective-observational-study-of-1092-cases
#11
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
OBJECTIVES: 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-centre 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
https://www.readbyqxmd.com/read/29374983/management-of-twin-twin-transfusion-syndrome-with-an-extremely-short-cervix
#12
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...
April 2018: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/29353282/differential-changes-in-myocardial-performance-index-and-its-time-intervals-in-donors-and-recipients-of-twin-to-twin-transfusion-syndrome-before-and-after-laser-therapy
#13
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
https://www.readbyqxmd.com/read/29338992/subsequent-fertility-pregnancy-and-gynecologic-outcomes-after-fetoscopic-laser-therapy-for-twin-twin-transfusion-syndrome-compared-with-normal-monochorionic-twin-gestations
#14
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 for twin-twin transfusion syndrome has been reported. However, little is known about the medium-term maternal effects after fetoscopic laser therapy with respect to reproductive and gynecologic outcomes. OBJECTIVE: The objective of this study was to document reproductive, obstetric, gynecological, and psychological outcomes in women who underwent fetoscopic laser therapy for twin-twin transfusion syndrome...
April 2018: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29332067/incidence-of-and-risk-factors-for-residual-anastomoses-in-twin-twin-transfusion-syndrome-treated-with-laser-surgery-a-15-year-single-center-experience
#15
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
https://www.readbyqxmd.com/read/29320800/risks-of-preterm-premature-rupture-of-membranes-and-preterm-birth-post-fetoscopy-based-on-location-of-trocar-insertion-site
#16
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
https://www.readbyqxmd.com/read/29314091/the-relationship-between-preoperative-fetal-head-circumference-and-2-year-cognitive-performance-after-laser-surgery-for-twin-twin-transfusion-syndrome
#17
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...
February 2018: Prenatal Diagnosis
https://www.readbyqxmd.com/read/29207382/incidental-septostomy-after-laser-surgery-for-twin-twin-transfusion-syndrome-perinatal-outcomes-and-antenatal-management
#18
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
https://www.readbyqxmd.com/read/29172821/risk-of-donor-demise-after-laser-therapy-for-twin-twin-transfusion-when-complicated-by-growth-discordance-and-abnormal-umbilical-artery-doppler-findings
#19
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
https://www.readbyqxmd.com/read/29122542/twin-twin-transfusion-syndrome-what-we-have-learned-from-clinical-trials
#20
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...
December 2017: Seminars in Fetal & Neonatal Medicine
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