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.

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.

Disentanglement of Discordant Monochorionic-Monoamniotic Twins in a Triplet Pregnancy: An Innovative Approach Utilizing Fetoscopic Laser Coagulation with Micro-Laparoscopic Scissor Dissection

2015 ◽  
Vol 40 (4) ◽  
pp. 303-305
Author(s):  
Nadia B. Kunzier ◽  
Baraa Allaf ◽  
Martin R. Chavez ◽  
Diana Abenanti-Richmond ◽  
Anthony M. Vintzileos
Keyword(s):  
Umbilical Cord ◽  
Fetal Death ◽  
Neurological Injury ◽  
Intrauterine Fetal Death ◽  
Laser Coagulation ◽  
Perinatal Morbidity ◽  
Multiple Pregnancies ◽  
Triplet Pregnancy ◽  
Increased Risk ◽  
Fetoscopic Laser Coagulation

Triplet gestations are associated with high perinatal morbidity. Dichorionic-diamniotic triplet pregnancies with growth discordance, polyhydramnios and structural anomalies carry a significantly increased risk of fetal morbidity and mortality from the baseline risks of high-order multiple pregnancies. Intrauterine fetal death of one fetus of a monochorionic pregnancy may cause neurological injury to the surviving fetus. We present a case where an innovative technique was created combining use of the fetoscopic laser and miniature laparoscopic instruments to selectively reduce and disentangle the umbilical cord of the acranial growth-restricted fetus from the structurally normal fetus's umbilical cord in a dichorionic-diamniotic triplet pregnancy.

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 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.

Septostomy during laser surgery for twin-to-twin transfusion syndrome

GYNECOLOGY ◽  
2021 ◽  
Vol 23 (4) ◽  
pp. 324-329
Author(s):  
Andrei E. Bugerenko ◽  
Liya N. Shcherbakova ◽  
Olga B. Panina
Keyword(s):  
Surgical Techniques ◽  
Perinatal Outcomes ◽  
Uterine Wall ◽  
The Body ◽  
Laser Coagulation ◽  
Delivery Time ◽  
Trocar Insertion ◽  
Increased Risk ◽  
Fetoscopic Laser Coagulation ◽  
Umbilical Cords

Aim. To assess the perinatal outcomes of monochorionic diamniotic (MCDA) pregnancy after fetoscopic laser coagulation of anastomoses (FLCA) performed for twin-to-twin transfusion syndrome (TTTS), accompanied by induced or unintentional septostomy, and to identify the factors leading to septostomy. Materials and methods. The retrospective study included 231 cases of FLCA performed in pregnant women with TTTS: in 19 cases septostomy was performed, and in 212 cases intertwin membrane remained intact. Results. The incidence of septostomy during FLCA for TTTS was 8.2%. In 47.3% the rupture of the intertwin membrane occurred during trocar insertion (unintentional septostomy); in 42.1% septostomy was needed to perform laser coagulation of anastomoses located on the placental surface in the donor's amnion (forced septostomy). The placenta was located on the anterior uterine wall in 78.9% in the septostomy group and in 47.6% with an intact intertwin membrane (p=0.01). Anastomoses were located on the donor half of the placenta significantly more often when septostomy was needed to perform selective coagulation of anastomoses located far from the intertwin membrane and obstructed by the body of the donor fetus (42.1%). In 15.8% of patients with septostomy and 2.4% with intact intertwin membrane, umbilical cords of the donor and the recipient fetus were attached closer than 2 cm to each other (p=0.003). In the septostomy group premature rupture of membranes was more frequent (42.1% vs 18.4%, p=0.03) and a delivery time was shorter [26.3 (18.0, 37.0) vs 34.4 (20.3, 40.0) weeks, respectively, p=0.01] than in patients with an intact intertwin membrane. The survival rate after FLCA was lower after septostomy compared to intact intertwin membrane: at least one of the twins survived in 47.4% vs 80.7%, respectively (p=0.002), both fetuses survived in 36.8% vs 75.0%, respectively (p=0.001). Logistic regression analysis showed increased risk of septostomy in patients with the anastomoses located on the donor half of the placenta and when the donor and the recipient umbilical cords are attached close to each other, regardless of the localization of the placenta, gestational age and the stage of TTTS. Conclusion. Lower incidence of unintentional septostomy during FLCA achieved by using modern equipment and surgical techniques will lead to better perinatal outcomes in patients with MCDA twins with TTTS.

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.

scholarly journals Long term alterations of growth after antenatal steroids in preterm twin pregnancies

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Thorsten Braun ◽  
Vivien Filleböck ◽  
Boris Metze ◽  
Christoph Bührer ◽  
Andreas Plagemann ◽  
...  
Keyword(s):  
Early Childhood ◽  
Disease Risk ◽  
Later Life ◽  
Ponderal Index ◽  
Childhood Growth ◽  
Antenatal Steroids ◽  
Increased Risk ◽  
Infancy And Early Childhood ◽  
Twin Pregnancies

AbstractObjectivesTo compare the long-term effects of antenatal betamethasone (ANS, ≤16 mg, =24 mg and >24 mg) in twins on infant and childhood growth.MethodsA retrospective cohort follow up study among 198 twins after ANS including three time points: U1 first neonatal examination after birth and in the neonatal period; U7 examination from the 21st to the 24th month of life and U9 examination from the 60th to the 64th month of life using data from copies of the children’s examination booklets. Inclusion criteria are twin pregnancies with preterm labor, cervical shortening, preterm premature rupture of membranes, or vaginal bleeding, and exposure to ANS between 23+5 and 33+6 weeks. Outcome measures are dosage-dependent and sex-specific effects of ANS on growth (body weight, body length, head circumference, body mass index and ponderal index) up to 5.3 years.ResultsOverall, 99 live-born twin pairs were included. Negative effects of ANS on fetal growth persisted beyond birth, altered infant and childhood growth, independent of possible confounding factors. Overall weight percentile significantly decreased between infancy and early childhood by 18.8%. Birth weight percentiles significantly changed in a dose dependent and sex specific manner, most obviously in female-female and mixed pairs. The ponderal index significantly decreased up to 42.9%, BMI index increased by up to 33.8%.ConclusionsANS results in long-term alterations in infant and childhood growth. Changes between infancy and early childhood in ponderal mass index and BMI, independent of dose or twin pair structure, might indicate an ANS associated increased risk for later life disease.SynopsisFirst-time report on long-term ANS administration growth effects in twin pregnancies, showing persisting alterations beyond birth in infant and childhood growth up to 5.3 years as potential indicator of later life disease risk.

scholarly journals Upper GI Bleeding Secondary to Radiation Gastritis in a Patient with Preexisting Portal Hypertensive Gastropathy

2021 ◽  
pp. 513-518
Author(s):  
Samragnyi Madala ◽  
Abhishek Polavarapu ◽  
Dhineshreddy Gurala ◽  
Vivek Gumaste
Keyword(s):  
Radiation Therapy ◽  
Gastrointestinal Bleeding ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Laser Coagulation ◽  
Portal Hypertensive Gastropathy ◽  
Gastrointestinal Malignancy ◽  
Nonalcoholic Fatty Liver ◽  
Increased Risk ◽  
Radiation Induced

We commonly see patients presenting with either portal hypertensive gastropathy (PHG) or radiation gastritis. Radiation-induced hemorrhagic gastritis is an unusual lethal complication postradiation. Patients with preexisting PHG have very friable mucosa that can easily bleed after radiation for cancer treatment. There is an increased risk of bleeding with both entities present together. Our aim is to focus on treatment and possible prevention of gastrointestinal bleeding in patients with preexisting PHG undergoing radiation therapy for newly diagnosed cancer. Several therapies like prednisolone, argon plasma coagulation, laser coagulation have been proposed. There are no set guidelines for treatment. In these patients, if radiation therapy is indicated either for hepatic or gastrointestinal malignancy, it is suggested to premedicate with proton pump inhibitors or sucralfate. We describe a case of 73-year-old female who presented with upper gastrointestinal bleeding. She had liver cirrhosis secondary to nonalcoholic fatty liver disease and diagnosed with pancreatic cancer, for which she received chemoradiation. She was found to have both radiation gastritis and PHG with diffuse erythematous, edematous, congested mucosa with diffuse oozing blood in the antrum making it very challenging to treat.

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