Doppler assessment of patients with twin‐to‐twin transfusion syndrome and survival following fetoscopic laser surgery

Guevara, Enrique Gil; Pazos, Andrea; Gonzalez, Otilia; Carretero, Pilar; Molina, Francisca S.

doi:10.1002/ijgo.12143

Cited by 12 publications

(13 citation statements)

References 16 publications

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“…The question whether echocardiographic parameters should be included in the TTTS staging system remains unanswered. Most studies investigating the association between assessment of cardiac function and IUFD include neonatal demise instead of fetal demise as their endpoint . A large amount of data reflecting cardiac function had therefore been excluded from this systematic review.…”

Section: Discussionmentioning

confidence: 99%

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The value of echocardiography and Doppler in the prediction of fetal demise after laser coagulation for TTTS: A systematic review and meta‐analysis

et al. 2019

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This study aimed to investigate the value of echocardiography and Doppler before fetoscopic laser coagulation for twin‐twin transfusion syndrome (TTTS) in the prediction of intrauterine fetal demise (IUFD). We performed a systematic review and meta‐analysis to compare preoperative parameters between fetuses with and without demise after laser surgery. Eighteen studies were included. Recipient twins have an increased risk of demise in case of preoperative absent/reversed flow (A/REDF) in the umbilical artery (odds ratio [OR] 2.76, 95% confidence interval [CI], 1.78‐4.28), absent or reversed a‐wave in the ductus venosus (OR 2.32, 95% CI, 1.70‐3.16), or a middle cerebral artery peak systolic velocity > 1.5 multiples of the median (MoM) (OR 7.59, 95% CI, 2.56‐22.46). In donors, only A/REDF in the umbilical artery (OR 3.40, 95% CI, 2.68‐4.32) and absent or reversed a‐wave in the ductus venosus (OR 1.66, 95% CI, 1.12‐2.47) were associated with IUFD. No association was found between donor‐IUFD and preoperative myocardial performance index (MPI). Two studies found an association between abnormal MPI and recipient demise. With this study, we have identified a set of preoperative Doppler parameters predictive of fetal demise after laser surgery. More research is needed to assess the utility of preoperative echocardiographic parameters such as the MPI in predicting IUFD.

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Section: Discussionmentioning

confidence: 99%

“…Most studies investigating the association between assessment of cardiac function and IUFD include neonatal demise instead of fetal demise as their endpoint. [44][45][46][47][48][49] A large amount of data reflecting cardiac function had therefore been excluded from this systematic review.…”

Section: Discussionmentioning

confidence: 99%

The value of echocardiography and Doppler in the prediction of fetal demise after laser coagulation for TTTS: A systematic review and meta‐analysis

et al. 2019

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“…Fetoscopic laser coagulation (FLC) of the placental anastomoses is the first line treatment between 16 and 27 weeks. It eliminates the etiological cause of TTTS resulting in double survival in 70% of the cases and a least one fetus surviving in 85% of the cases (25) .…”

Section: Managementmentioning

confidence: 99%

“…Mild TTTS in the context of sFGR has high incidence of adverse outcome and it may be considered an indication for active management (25,30) .…”

Section: Selective Fetal Growth Restriction (Sfgr)mentioning

confidence: 99%

Cirugía láser fetoscópica en el síndrome de transfusión feto fetal

Pugliese¹

2018

Rev peru ginecol obstet.

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El síndrome de transfusión de gemelo a gemelo (TTTS) complica alrededor del 10% de todos los embarazos monocoriónicos (MC). Un flujo sanguíneo intergemelar neto, predominantemente unidireccional, a través de anastomosis vasculares placentarias, desencadena una variedad de alteraciones renales y cardiovasculares complejas en ambos fetos. Sin tratamiento, el TTTS grave conduce a una mortalidad superior al 80% y una morbilidad del 15 a 50% en los sobrevivientes. La coagulación láser fetoscópica (CLF) de las anastomosis placentarias es el tratamiento de elección para casos graves antes de las 27 semanas y ha demostrado mejorar los resultados perinatales. El riesgo de rotura prematura de membranas (RPM) y de prematuridad asociada a CLF se debe sopesar con el riesgo de la conducta expectante en cada caso particular. Dado que no hay una manera precisa de predecir la evolución de la enfermedad, y no se ha descrito aun ningún método eficaz para prevenir la RPM posterior al procedimiento, la indicación de la CLF es tan desafiante como el procedimiento en sí mismo.

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“…The technique consists of the coagulation of placental anastomosis that exists between both fetuses that cause TTTs through a 3‐mm trocar. The short‐term risks of this procedure are a recurrence of TTTs, the twin anemia polycythemia sequence (TAPS), late miscarriage, in utero fetal death of 1 or both twins, or cerebral damage for 1 or both twins . Twins treated for TTTs are usually delivered at 34 weeks of gestation (WG) by cesarean section.…”

Section: Introductionmentioning

confidence: 99%

Impact of laser therapy for twin‐to‐twin transfusion syndrome on subsequent pregnancy

Lous¹,

Mediouni

Chalouhi

et al. 2018

Prenatal Diagnosis

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Doppler assessment of patients with twin‐to‐twin transfusion syndrome and survival following fetoscopic laser surgery

Cited by 12 publications

References 16 publications

The value of echocardiography and Doppler in the prediction of fetal demise after laser coagulation for TTTS: A systematic review and meta‐analysis

The value of echocardiography and Doppler in the prediction of fetal demise after laser coagulation for TTTS: A systematic review and meta‐analysis

Cirugía láser fetoscópica en el síndrome de transfusión feto fetal

Impact of laser therapy for twin‐to‐twin transfusion syndrome on subsequent pregnancy

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