Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology · 2000
Sono-endoscopic delineation of the placental vascular equator prior to selective fetoscopic laser ablation in twin-to-twin transfusion syndrome.
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Thilaganathan B, Gloeb D J, Sairam S, Tekay A
Аннотация
OBJECTIVE: To assess the safety and efficacy of a new fetoscopic technique in the management of twin-to-twin transfusion syndrome.
STUDY DESIGN: Prospective study of fetoscopic treatment and outcome in 10 pregnancies complicated by severe twin-to-twin transfusion syndrome before 24 weeks' gestation. The sono-endoscopic approach was used to identify the placental vascular equator and photocoagulate any vessels crossing this threshold.
RESULTS: The mean gestation at treatment was 20 weeks and 3 days. An average of three to four vessels were ablated during each procedure, with a mean operative time of 24 min (range, 14-31 min). The overall survival rate was 55% (11 of 20) with at least one survivor in 70% (seven of 10) of pregnancies.
CONCLUSIONS: Fetoscopic laser ablation is a safe and effective form of treatment in the management of severe twin-to-twin transfusion syndrome. This technique, where vessels crossing the placental vascular equator are identified and photocoagulated fetoscopically, is an alternative to the non-selective and selective methods described previously. This new approach is associated with a shorter operating time, less damage to the normal placental surface vasculature and with survival results that are at least as promising as previously reported techniques.
STUDY DESIGN: Prospective study of fetoscopic treatment and outcome in 10 pregnancies complicated by severe twin-to-twin transfusion syndrome before 24 weeks' gestation. The sono-endoscopic approach was used to identify the placental vascular equator and photocoagulate any vessels crossing this threshold.
RESULTS: The mean gestation at treatment was 20 weeks and 3 days. An average of three to four vessels were ablated during each procedure, with a mean operative time of 24 min (range, 14-31 min). The overall survival rate was 55% (11 of 20) with at least one survivor in 70% (seven of 10) of pregnancies.
CONCLUSIONS: Fetoscopic laser ablation is a safe and effective form of treatment in the management of severe twin-to-twin transfusion syndrome. This technique, where vessels crossing the placental vascular equator are identified and photocoagulated fetoscopically, is an alternative to the non-selective and selective methods described previously. This new approach is associated with a shorter operating time, less damage to the normal placental surface vasculature and with survival results that are at least as promising as previously reported techniques.