Ultrasound assessment prior to laser photocoagulation for twin-twin transfusion syndrome for predicting intrauterine fetal demise after surgery in Japanese patients
ABSTRACT To evaluate the use of ultrasound before selective laser photocoagulation of communicating vessels (SLPCV) for twin-twin transfusion syndrome in predicting intrauterine fetal demise (IUFD).
Fifty-five patients underwent SLPCV in Japan. Fetal biometry and Doppler studies of the umbilical artery, ductus venosus, and umbilical vein were performed prior to SLPCV. The visualization of the bladder and hydrops was recorded. Association between the parameters and IUFD was analyzed using multiple logistic regression analysis. The study was approved by the Institutional Review Board and patients gave their informed consent.
The IUFD incidence was 25.5% (14/55) in the donors and 12.7% (7/55) in the recipients. Twelve donors and 4 recipients of them ended in unexplainable IUFD. In the analysis of 53 donors, absent or reversed end-diastolic flow of umbilical artery (UAAREDF) was only associated with IUFD (p = 0.016). No parameters could predict IUFD in 52 recipients.
UAAREDF may be useful for predicting IUFD of the donor after SLPCV.
SourceAvailable from: Colin A Walsh[Show abstract] [Hide abstract]
ABSTRACT: Objective: Selective fetoscopic laser photocoagulation (SFLP) is now the treatment of choice for twin-twin transfusion syndrome (TTTS). The incidence of recurrent TTTS following SFLP has been inconsistently reported across different studies. We performed a systematic review of TTTS recurrence following SFLP. Methods: Pubmed and Medline online databases were searched for articles published between 2000 and August 2011, using combinations of the terms "twin-twin transfusion", "TTTS", "laser", "recur" and "outcome". Citations identified in the primary search were screened for eligibility. Studies reporting outcomes from selective SFLP for TTTS in twin pregnancies, which addressed specifically the issue of TTTS recurrence, were included. The primary outcome was rate of TTTS recurrence. Secondary outcomes were therapeutic preference and fetal outcomes in cases of recurrent TTTS. Results: The primary search identified 22 eligible studies which were included in this review (n=2,447 twin pregnancies). Two studies included a minority of non-selective procedures. The published incidence of recurrent TTTS ranged from 0-16%. Clinical management was reported in 66% (71/108) cases, with repeat SFLP the most commonly performed secondary intervention. Only 3 studies provided comprehensive outcome data for cases of recurrent TTTS. The overall rate of neurologically-intact survival was 38% (20/52). Data were insufficient to determine the effects of secondary therapeutic approach, placental location or gestational age on perinatal outcome in cases of recurrent TTTS. Conclusions: The published rate of TTTS recurrence following SFLP in monochorionic twin pregnancy ranges from 0-16%. Although limited follow-up data suggest recurrence is associated with significant perinatal mortality and morbidity, further study is needed. Currently, there are insufficient data available to guide recommendations for clinical management of TTTS recurrence. Future studies on SFLP for TTTS must include details on recurrence rates and provide outcome data specific to the recurrent subset. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.Ultrasound in Obstetrics and Gynecology 11/2012; 40(5). DOI:10.1002/uog.11105 · 3.14 Impact Factor
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ABSTRACT: To evaluate the independent and combined value of gestational age, fetal weight, feto-placental Doppler, and myocardial performance index for the prediction of individual risk of early (≤7 days) intrauterine fetal death (IUFD) after laser therapy in twin-twin transfusion syndrome (TTTS). A consecutive series of 215 cases of TTTS treated with laser therapy in 3 centers was prospectively studied. Ultrasound evaluation within 24 hours of surgery included estimated fetal weight discordance (EFWD), umbilical artery (UA) pulsatility index (PI) and diastolic flow evaluation, middle cerebral artery PI (MCAPI) and peak systolic velocity (MCAPSV), ductus venosus PI and atrial flow assessment and modified myocardial performance index. Logistic regression analysis was used to explore the association of preoperative parameters with IUFD. IUFD occurred in 17 (7.9%) of recipients and 33 (15.3%) donors (p = 0.016). The only independent predictors of IUFD in recipients was MCAPSV > 1.5MoM (OR = 22, p = 0.015), but this event was present in only 3% of recipients. In donors, reverse end diastolic flow in the UA (OR = 14.748, p = 0.033), EFWD (OR = 1.054, p = 0.036) and gestational age (OR = 0.757, p = 0.046) were independent predictors. In TTTS, preoperative fetal assessment can identify independent risk factors for early postoperative IUFD, particularly in donors. This article is protected by copyright. All rights reserved.Prenatal Diagnosis 11/2013; 33(11). DOI:10.1002/pd.4191 · 2.51 Impact Factor
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ABSTRACT: Objective To evaluate the outcomes of fetoscopic laser photocoagulation (FLP) for a triplet gestation with feto-fetal transfusion syndrome (FFTS).Method Based on chorionicity, perinatal outcome at 28 days in triplets with FFTS after FLP were evaluated.ResultsFLP was completed for all 16 cases including nine dichorionic triamniotic (DT) cases and seven monochorionic triamniotic (MT) cases. The placenta was located anteriorally in six cases. The median gestational age at surgery was 21 (16-25) weeks and median operation time was 51 (25-125) minutes. Several technical maneuvers to complete the procedure in MT, such as trocar assistance in two cases, intentional septostomy of the dividing membrane in one, and double uterine entry in one, were used. The median gestational age at delivery was 31 (23-34) weeks. Overall perinatal survival in DT was 74%; that of MT was 95%. All 16 cases resulted in at least one survival, whereas three neonates survived in 44% of DT cases and in 86% of MT cases. Two MT neonates suffered severe intraventricular hemorrhages.ConclusionsFLP for FFTS in MT as well as DT triplets seems a valuable treatment. This article is protected by copyright. All rights reserved.Prenatal Diagnosis 08/2014; 34(8). DOI:10.1002/pd.4357 · 2.51 Impact Factor