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.

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.

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.

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.

Demonstration of Placental Vascular Anatomy in Monochorionic Twin Gestations

2002 ◽  
Vol 5 (1) ◽  
pp. 37-44 ◽  
Author(s):  
Monique E. De Paepe ◽  
Sarah Burke ◽  
Francois I. Luks ◽  
Halit Pinar ◽  
Don B. Singer
Keyword(s):  
Vascular Anatomy ◽  
Treatment Modalities ◽  
Laser Coagulation ◽  
Injection Technique ◽  
Invasive Treatment ◽  
Monochorionic Twin ◽  
Macroscopic Classification ◽  
Fetoscopic Laser Coagulation

Invasive treatment modalities for severe chronic twin-to-twin transfusion syndrome (TTTS), such as fetoscopic laser coagulation of communicating vessels, have revived the need for detailed studies of placental angioar-chitecture. We describe a practical placental vascular injection technique using alcohol-resistant tissue-staining dyes. Injection of color-coded gelatin-dye mixtures effectively delineated the intertwin vasculature, and allowed unequivocal macroscopic classification of vascular communications as artery-to-artery, vein-to-vein, or deep artery–to-vein anastomoses. The existence of deep artery–to-vein anastomoses was further confirmed by light microscopic demonstration of venous dye of one twin and arterial dye of the opposite twin within the same stem villus. Furthermore, the injection technique allowed determination of the caliber of the anastomoses, the direction of the artery-to-vein anastomoses, and the relative vascular territory of each twin. Documenting the vascular communications in monochorionic twin placentas with and without TTTS may enhance our understanding of the pathogenesis of chronic TTTS. Correlating the anastomotic patterns and location of the laser coagulation scars with post-ablation outcome will aid in the design of rational therapeutic methods for this often lethal condition.

scholarly journals Fetoscopic laser coagulation in 1020 pregnancies with twin-twin transfusion syndrome demonstrates improvement in double-twin survival rate

2017 ◽  
Vol 50 (6) ◽  
pp. 728-735 ◽  
Author(s):  
W. Diehl ◽  
A. Diemert ◽  
D. Grasso ◽  
S. Sehner ◽  
K. Wegscheider ◽  
...  
Keyword(s):  
Survival Rate ◽  
Laser Coagulation ◽  
Fetoscopic Laser Coagulation ◽  
Double Twin

scholarly journals Fetoscopic laser coagulation of intertwin anastomoses reduces discordant placental autophagic activities in discordant twin growth

2015 ◽  
Vol 54 (5) ◽  
pp. 580-582 ◽  
Author(s):  
Yao-Lung Chang ◽  
Tzu-Hao Wang ◽  
Shuenn-Dyh Chang ◽  
An-Shine Chao ◽  
Peter C.C. Hsieh
Keyword(s):  
Laser Coagulation ◽  
Fetoscopic Laser Coagulation ◽  
Twin Growth ◽  
Discordant Twin

Twin-to-twin transfusion syndrome. A 15-year experience in using fetoscopic therapy

2021 ◽  
Vol 20 (5) ◽  
pp. 58-62
Author(s):  
A.E. Bugerenko ◽  
Keyword(s):  
Key Words ◽  
Russian Federation ◽  
Laser Coagulation ◽  
The World ◽  
Fetoscopic Laser Coagulation ◽  
The Russian Federation

This article presents the aspects of fetoscopic laser coagulation of anastomoses (FLCA) for treatment of twin-to-twin transfusion syndrome in the Russian Federation and worldwide. Own experience is correlated with the world one. There is a significant need for domestic medicine to increase the number of clinics that provide this type of intervention. Nevertheless, there is no obvious lag in comparing the results of FLCA in the Russian Federation. Key words: monochorionic pregnancy, fetoscopy, laser coagulation of anastomoses, twin-to-twin transfusion syndrome

scholarly journals OC22.06: Short‐term cardiac follow‐up of survivors of Twin–twin transfusion syndrome treated with fetoscopic laser coagulation

2019 ◽  
Vol 54 (S1) ◽  
pp. 58-58
Author(s):  
M. Gijtenbeek ◽  
M.C. Haak ◽  
S. Eschbach ◽  
A.M. Middeldorp ◽  
F.J. Klumper ◽  
...  
Keyword(s):  
Laser Coagulation ◽  
Short Term ◽  
Fetoscopic Laser Coagulation

418: The impact of fetoscopic access diameter after fetoscopic laser coagulation

2009 ◽  
Vol 201 (6) ◽  
pp. S161
Author(s):  
Scott Petersen ◽  
Paul Lewi ◽  
Anke Diemert ◽  
Glenn Gardener ◽  
Kurt Hecher ◽  
...  
Keyword(s):  
Laser Coagulation ◽  
Fetoscopic Laser Coagulation ◽  
The Impact
Sign in / Sign up

Export Citation Format

Share Document