selective fetoscopic laser photocoagulation of superficial placental anastomoses for the treatment of severe Twin-Twin transfusion syndrome

Rodrigo Ruano, Maria De Lourdes Brizot, Adolfo Wenjaw Liao, Marcelo Zugaib

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

OBJECTIVE: To report our initial institutional experience with fetoscopic laser photocoagulation of placental anastomoses in severe twin-twin transfusion syndrome using a 1.0 mm endoscope. METHODS: Between July 2006 and June 2008, 19 monochorionic diamniotic twin pregnancies complicated by severe TTTS (Quintero stages III and IV) underwent fetoscopic laser therapy. Perinatal data were prospectively collected and compared according to the Quintero stages. RESULTS: Nine patients were classified as stage III and ten as stage IV. The Mean gestational ages at diagnosis and procedure were 20 (range: 17-25) and 22.0 (range: 19.0-26.0) weeks, respectively, with no statistical difference between the two groups. Preterm premature rupture of the membranes occurred in two cases (10.5%), and spontaneous preterm delivery in eight (42.1%). Overall mean gestational age at delivery was 32.1 (range: 26.0-38.0) weeks. Prematurity was more severe in stage IV patients (p<0.01). Among all cases, the overall survival rate was 52.6%, and the percentages of pregnancies with survival of both babies and at least one twin were 26.3% and 78.9%, respectively. In the case of stage III patients, the overall survival rate was 61.1%. Of the stage III pregnancies, 33.3% resulted in both babies surviving, and 88.9% of these pregnancies resulted in at least one surviving twin. For stage IV, as the corresponding statistics were 45.0%, 20.0% and 70.0% respectively. CONCLUSIONS: Our initial institutional experience with 1.0 mm fetoscopic laser therapy for severe TTTS showed results similar to those reported in the literature for larger endoscopes.

Original languageEnglish (US)
Pages (from-to)91-96
Number of pages6
JournalClinics
Volume64
Issue number2
DOIs
StatePublished - Mar 9 2009
Externally publishedYes

Fingerprint

Fetofetal Transfusion
Light Coagulation
Lasers
Endoscopes
Laser Therapy
Pregnancy
Gestational Age
Survival Rate
Twin Pregnancy
Therapeutics
Survival

Keywords

  • Fetal surgery
  • Fetal therapy
  • Fetoscopy
  • Laser
  • Monochorionic twins.
  • Placenta
  • Prenatal diagnosis
  • Twin-twin transfusion syndrome

ASJC Scopus subject areas

  • Medicine(all)

Cite this

selective fetoscopic laser photocoagulation of superficial placental anastomoses for the treatment of severe Twin-Twin transfusion syndrome. / Ruano, Rodrigo; De Lourdes Brizot, Maria; Liao, Adolfo Wenjaw; Zugaib, Marcelo.

In: Clinics, Vol. 64, No. 2, 09.03.2009, p. 91-96.

Research output: Contribution to journalArticle

Ruano, Rodrigo ; De Lourdes Brizot, Maria ; Liao, Adolfo Wenjaw ; Zugaib, Marcelo. / selective fetoscopic laser photocoagulation of superficial placental anastomoses for the treatment of severe Twin-Twin transfusion syndrome. In: Clinics. 2009 ; Vol. 64, No. 2. pp. 91-96.
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abstract = "OBJECTIVE: To report our initial institutional experience with fetoscopic laser photocoagulation of placental anastomoses in severe twin-twin transfusion syndrome using a 1.0 mm endoscope. METHODS: Between July 2006 and June 2008, 19 monochorionic diamniotic twin pregnancies complicated by severe TTTS (Quintero stages III and IV) underwent fetoscopic laser therapy. Perinatal data were prospectively collected and compared according to the Quintero stages. RESULTS: Nine patients were classified as stage III and ten as stage IV. The Mean gestational ages at diagnosis and procedure were 20 (range: 17-25) and 22.0 (range: 19.0-26.0) weeks, respectively, with no statistical difference between the two groups. Preterm premature rupture of the membranes occurred in two cases (10.5{\%}), and spontaneous preterm delivery in eight (42.1{\%}). Overall mean gestational age at delivery was 32.1 (range: 26.0-38.0) weeks. Prematurity was more severe in stage IV patients (p<0.01). Among all cases, the overall survival rate was 52.6{\%}, and the percentages of pregnancies with survival of both babies and at least one twin were 26.3{\%} and 78.9{\%}, respectively. In the case of stage III patients, the overall survival rate was 61.1{\%}. Of the stage III pregnancies, 33.3{\%} resulted in both babies surviving, and 88.9{\%} of these pregnancies resulted in at least one surviving twin. For stage IV, as the corresponding statistics were 45.0{\%}, 20.0{\%} and 70.0{\%} respectively. CONCLUSIONS: Our initial institutional experience with 1.0 mm fetoscopic laser therapy for severe TTTS showed results similar to those reported in the literature for larger endoscopes.",
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T1 - selective fetoscopic laser photocoagulation of superficial placental anastomoses for the treatment of severe Twin-Twin transfusion syndrome

AU - Ruano, Rodrigo

AU - De Lourdes Brizot, Maria

AU - Liao, Adolfo Wenjaw

AU - Zugaib, Marcelo

PY - 2009/3/9

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N2 - OBJECTIVE: To report our initial institutional experience with fetoscopic laser photocoagulation of placental anastomoses in severe twin-twin transfusion syndrome using a 1.0 mm endoscope. METHODS: Between July 2006 and June 2008, 19 monochorionic diamniotic twin pregnancies complicated by severe TTTS (Quintero stages III and IV) underwent fetoscopic laser therapy. Perinatal data were prospectively collected and compared according to the Quintero stages. RESULTS: Nine patients were classified as stage III and ten as stage IV. The Mean gestational ages at diagnosis and procedure were 20 (range: 17-25) and 22.0 (range: 19.0-26.0) weeks, respectively, with no statistical difference between the two groups. Preterm premature rupture of the membranes occurred in two cases (10.5%), and spontaneous preterm delivery in eight (42.1%). Overall mean gestational age at delivery was 32.1 (range: 26.0-38.0) weeks. Prematurity was more severe in stage IV patients (p<0.01). Among all cases, the overall survival rate was 52.6%, and the percentages of pregnancies with survival of both babies and at least one twin were 26.3% and 78.9%, respectively. In the case of stage III patients, the overall survival rate was 61.1%. Of the stage III pregnancies, 33.3% resulted in both babies surviving, and 88.9% of these pregnancies resulted in at least one surviving twin. For stage IV, as the corresponding statistics were 45.0%, 20.0% and 70.0% respectively. CONCLUSIONS: Our initial institutional experience with 1.0 mm fetoscopic laser therapy for severe TTTS showed results similar to those reported in the literature for larger endoscopes.

AB - OBJECTIVE: To report our initial institutional experience with fetoscopic laser photocoagulation of placental anastomoses in severe twin-twin transfusion syndrome using a 1.0 mm endoscope. METHODS: Between July 2006 and June 2008, 19 monochorionic diamniotic twin pregnancies complicated by severe TTTS (Quintero stages III and IV) underwent fetoscopic laser therapy. Perinatal data were prospectively collected and compared according to the Quintero stages. RESULTS: Nine patients were classified as stage III and ten as stage IV. The Mean gestational ages at diagnosis and procedure were 20 (range: 17-25) and 22.0 (range: 19.0-26.0) weeks, respectively, with no statistical difference between the two groups. Preterm premature rupture of the membranes occurred in two cases (10.5%), and spontaneous preterm delivery in eight (42.1%). Overall mean gestational age at delivery was 32.1 (range: 26.0-38.0) weeks. Prematurity was more severe in stage IV patients (p<0.01). Among all cases, the overall survival rate was 52.6%, and the percentages of pregnancies with survival of both babies and at least one twin were 26.3% and 78.9%, respectively. In the case of stage III patients, the overall survival rate was 61.1%. Of the stage III pregnancies, 33.3% resulted in both babies surviving, and 88.9% of these pregnancies resulted in at least one surviving twin. For stage IV, as the corresponding statistics were 45.0%, 20.0% and 70.0% respectively. CONCLUSIONS: Our initial institutional experience with 1.0 mm fetoscopic laser therapy for severe TTTS showed results similar to those reported in the literature for larger endoscopes.

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KW - Fetal therapy

KW - Fetoscopy

KW - Laser

KW - Monochorionic twins.

KW - Placenta

KW - Prenatal diagnosis

KW - Twin-twin transfusion syndrome

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