scholarly journals Solomon Technique Versus Selective Coagulation for Twin–Twin Transfusion Syndrome

2016 ◽  
Vol 19 (3) ◽  
pp. 217-221 ◽  
Author(s):  
Femke Slaghekke ◽  
Dick Oepkes
Keyword(s):  
Neonatal Outcome ◽  
Survival Rates ◽  
Intrauterine Infection ◽  
Laser Coagulation ◽  
Preterm Premature Rupture ◽  
Fetoscopic Laser Coagulation ◽  
A New Technique ◽  
Solomon Technique ◽  
Twin Pregnancies ◽  
Selective Technique

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. The Solomon technique showed a reduction of recurrent TTS compared to the selective technique. The incidence of recurrent TTTS after the Solomon technique ranged from 0% to 3.9% compared to 5.3–8.5% after the selective technique. The incidence of TAPS after the Solomon technique ranged from 0% to 2.9% compared to 4.2–15.6% after the selective technique. The Solomon technique may improve dual survival rates ranging from 64% to 85% compared to 46–76% for the selective technique. There was no difference reported in procedure-related complications such as intrauterine infection and preterm premature rupture of membranes. The Solomon technique significantly reduced the incidence of TAPS and recurrent TTTS and may improve survival and neonatal outcome, without identifiable adverse outcome or complications; therefore, the Solomon technique is recommended for the treatment of TTTS.

Magnetic resonance imaging of the feto‐placentar unit after fetoscopic laser coagulation for twin‐to‐twin transfusion syndrome

2005 ◽  
Vol 46 (3) ◽  
pp. 328-330 ◽  
Author(s):  
T. A. G. M. Huisman ◽  
L. Lewi ◽  
R. Zimmermann ◽  
U. V. Willi ◽  
J. Deprest
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Mortality Rates ◽  
Laser Coagulation ◽  
Resonance Imaging ◽  
Fetal Magnetic Resonance Imaging ◽  
Imaging Tool ◽  
Fetoscopic Laser Coagulation ◽  
Twin Pregnancies ◽  
Oligohydramnios Sequence

Twin‐to‐twin transfusion syndrome (TTTS) is a severe complication in monochorionic twin pregnancies that results from a hemodynamical imbalance of placentar vascular anstomoses that connect the circulation of both fetuses. In TTTS, a poly/oligohydramnios sequence with high fetal morbidity and mortality rates occurs. Fetoscopic laser coagulation of the placentar anastomoses can limit or prevent fetal injury. The purpose of this report is to present and discuss fetal magnetic resonance imaging as a postoperative imaging tool after fetoscopic laser coagulation.

scholarly journals The Fetal Heart in Twin-to-Twin Transfusion Syndrome

2010 ◽  
Vol 2010 ◽  
pp. 1-8 ◽  
Author(s):  
Tim Van Mieghem ◽  
Liesbeth Lewi ◽  
Léonardo Gucciardo ◽  
Philip DeKoninck ◽  
Dominique Van Schoubroeck ◽  
...  
Keyword(s):  
Cardiac Dysfunction ◽  
Fetal Echocardiography ◽  
Pulmonary Stenosis ◽  
Laser Coagulation ◽  
Fetal Cardiac Function ◽  
Blood Exchange ◽  
Increased Risk ◽  
Staging Systems ◽  
Fetoscopic Laser Coagulation ◽  
Twin Pregnancies

Twin-to-twin transfusion syndrome is a severe complication occurring in 10% of monochorionic twin pregnancies. The disease is usually explained as due to an intrauterine imbalance in intertwin blood exchange, which leads to a volume depleted-donor twin and an overfilled recipient twin. The recipient has signs of cardiac dysfunction, which can be measured using echocardiography or blood and amniotic fluid derived biomarkers. Whereas cardiac dysfunction typically progresses in pregnancies treated with amniodrainage, it usually disappears within a few weeks after fetoscopic laser coagulation of the connecting intertwin anastomoses. Nevertheless, recipients remain at a increased risk of pulmonary stenosis. In this paper, we summarize the cardiac alterations in twin-to-twin transfusion syndrome, describe the changes seen after fetal therapy, list the newly proposed staging systems based on fetal cardiac function, and make recommendations about the use of fetal echocardiography in the evaluation and followup of pregnancies complicated by twin-to-twin transfusion syndrome.

Novel Application of Laparoscopic Ultrasound for Fetoscopic Laser Ablation in Twin-Twin Transfusion Syndrome with Complete Anterior Placenta

2015 ◽  
Vol 41 (1) ◽  
pp. 71-75 ◽  
Author(s):  
Marcus D. Jarboe ◽  
Deborah R. Berman ◽  
Tiffany Wright ◽  
Marjorie C. Treadwell ◽  
George B. Mychaliska
Keyword(s):  
Laparoscopic Ultrasound ◽  
Laser Coagulation ◽  
Transabdominal Ultrasound ◽  
Modified Technique ◽  
Lateral Entry ◽  
Trocar Placement ◽  
Window Current ◽  
Fetoscopic Laser Coagulation ◽  
Laparoscopic Assisted ◽  
Twin Pregnancies

Fetoscopic laser coagulation of the placental communicating vessels has become the standard treatment for monochorionic/diamniotic twin pregnancies complicated by severe twin-twin transfusion syndrome. Fetoscopic trocar placement can be performed with transabdominal ultrasound guidance with a posterior placenta and most anterior placentas that have a safe avascular window for entry. However, trocar insertion is challenging in cases of a complete anterior placenta without an avascular window. Current techniques to deal with this situation include mini-laparotomy with exteriorization to allow for dorsal entry, percutaneous lateral entry under transabdominal ultrasound/Doppler guidance, and laparoscopic assisted access with direct visualization of trocar entry. We describe a modified technique of laparoscopic assisted fetoscopic trocar placement using a laparoscopic ultrasound probe, which allows for precise, real-time guidance of trocar placement.

scholarly journals Fetoscopic Laser Coagulation in Twin-Twin Transfusion Syndrome: Case Series

2018 ◽  
Vol 24 (1) ◽  
pp. 52
Author(s):  
Aykan Yucel ◽  
Dilek Uygur
Keyword(s):  
Randomized Clinical Trials ◽  
Survival Rates ◽  
Case Series ◽  
Practice Research ◽  
Laser Coagulation ◽  
Perinatal Morbidity ◽  
Health Practice ◽  
Therapeutic Approaches ◽  
Fatal Complication ◽  
Fetoscopic Laser Coagulation

<p>Twin-to-twin transfusion syndrome is a fatal complication and twins with monochorionic/diamniotic placentas are affected due to placental vascular anastomoses, producing volume transfer of blood from one twin to the other. The donor twin becomes hypovolemic with oligohydramnios and the recipient becomes hypervolemic with polyhydramnios. Twin-to-twin transfusion syndrome is associated with increased perinatal morbidity and mortality and expresses longstanding health hazards. Serial amnioreduction and fetoscopic laser photocoagulation of the vascular anastomoses are the main therapeutic approaches for twin-to-twin transfusion syndrome. Higher survival rates after fetoscopic laser ablation of the anastomotic vessels in comparison to serial amnioreduction have been reported in multicenter randomized clinical trials. We report the fetoscopic laser coagulation of three twin-to-twin transfusion syndrome cases at Ankara Dr. Zekai Tahir Burak Health Practice Research Center, Perinatology Clinics. </p>

scholarly journals Relapse of Human Chorionic Gonadotropin-Induced Hyperthyroidism and Severe Hyperemesis Gravidarum Secondary to Twin-Twin Transfusion Syndrome, With Rapid Recovery Following Fetoscopic Laser Coagulation: Case Report

2021 ◽  
Vol 12 ◽  
Author(s):  
Faiza Lamine ◽  
Chiara Camponovo ◽  
David Baud ◽  
Dominique Werner ◽  
Laura Marino ◽  
...  
Keyword(s):  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Twin Pregnancy ◽  
Assisted Reproductive Technologies ◽  
Hyperemesis Gravidarum ◽  
Reproductive Technologies ◽  
Laser Coagulation ◽  
Monochorionic Twin ◽  
Fetoscopic Laser Coagulation ◽  
Twin Pregnancies

BackgroundLimited data have shown that, compared to uncomplicated twin pregnancies, pregnancies complicated by twin-twin transfusion syndrome (TTTS), a life-threatening condition, are associated with higher maternal serum levels of both human chorionic gonadotropin (hCG) and thyroid hormones. With the continuing expansion of assisted reproductive technologies, the rate of twin pregnancies, including those complicated by TTTS and associated hyperemesis gravidarum, is expected to increase further. Therefore, detailed descriptions of the maternal and fetal clinical outcomes of maternal thyrotoxicosis linked to TTTS can be useful for timely diagnosis and management. However, such descriptions are currently lacking in the literature.Case PresentationWe report the case of a 30-year-old woman carrying a monochorionic twin pregnancy complicated by TTTS that induced a relapse of severe hyperemesis gravidarum with overt non-autoimmune hyperthyroidism at 17 weeks of gestation. Following fetoscopic laser coagulation (FLC), both hyperemesis and hyperthyroidism improved within 1 week.ConclusionsThe present experience contributes to the knowledge base on maternal thyrotoxicosis linked to TTTS and can be useful in the diagnosis and treatment of future cases; it also emphasizes the need for a high degree of clinical suspicion and for close collaboration between endocrinologists and obstetricians. Another key point is that TTTS-associated hyperemesis gravidarum and maternal hyperthyroidism should be considered in the differential diagnosis of refractory or relapsing hyperemesis gravidarum in women with monochorionic twin pregnancy, because this condition may require more stringent supportive treatment before and during the FLC procedure when the mother is overtly hyperthyroid.

Preterm Premature Rupture of Membranes

2021 ◽  
Author(s):  
Daniel Castro ◽  
Errol R. Norwitz
Keyword(s):  
Broad Spectrum ◽  
Gestational Age ◽  
Inpatient Care ◽  
Expectant Management ◽  
Intrauterine Infection ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Preterm Premature Rupture ◽  
Broad Spectrum Antibiotics ◽  
Twin Pregnancies

Preterm premature rupture of membranes (PPROM) refers to rupture of the fetal membranes prior to 37-0/7 weeks’ gestation and prior to the onset of labor. PPROM complicates 2-4% of singleton pregnancies and 7-20% of twin pregnancies, and has been implicated in 30-40% of preterm births. Antepartum management involves confirming the diagnosis, excluding contraindications to expectant management (such as stillbirth, nonreassuring fetal testing, and intrauterine infection), and continued inpatient care with perinatology/NICU consultation, antenatal corticosteroids, broad-spectrum antibiotics (to prolong latency), and serial fetal surveillance. Delivery is indicated in the setting of nonreassuring fetal testing, intrauterine infection, excessive vaginal bleeding, preterm labor, and/or a gestational age of 34 weeks or beyond. Latency (time from rupture of membranes to delivery) depends on gestational age, severity of oligohydramnios, number of fetuses (shorter in twins), pregnancy complications (placental abruption, infection), fetal wellbeing, and use of broad-spectrum antibiotics. PPROM cannot be accurately predicted or prevented. Appropriate evidence-based management is essential to optimize outcome for both the mother and fetus in the setting of PPROM. This review contains 1 table, 2 figures and 57 references. Key words: chorioamnionitis, preterm birth, perinatal morbidity, twin pregnancies, preterm premature rupture of membranes (PPROM), fetal complications, maternal complications, labor and delivery, inpatient care, antepartum management

scholarly journals Fetoscopic laser coagulation for twin-twin transfusion syndrome before 17 weeks' gestation: laser data, complications and neonatal outcome

2014 ◽  
Vol 44 (3) ◽  
pp. 299-303 ◽  
Author(s):  
L. Lecointre ◽  
N. Sananes ◽  
A. S. Weingertner ◽  
M. Kohler ◽  
F. Guerra ◽  
...  
Keyword(s):  
Neonatal Outcome ◽  
Laser Coagulation ◽  
Laser Data ◽  
Fetoscopic Laser Coagulation
Sign in / Sign up

Export Citation Format

Share Document