Expectant management versus multifetal pregnancy reduction in dichorionic triamniotic (DCTA) triplets: Single centre experience

Shaw, Caroline J.; Paramasivam, G.; Vacca, C.; Lees, C.

doi:10.1016/j.ejogrb.2021.07.021

Cited by 6 publications

(13 citation statements)

References 22 publications

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“…Figure 1 shows the study flow chart with included and excluded items (and the reasons for their exclusions). Forty-one articles were considered, including 194 cases of TRAP sequence [6,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24], 56 cases of BPSs [25][26][27][28][29][30][31][32][33][34][35][36], 5 cases of placental chorioangiomas (PCAs) [37][38][39], 11 cases of sacrococcygeal teratoma (SCT) [40][41][42][43], and 103 cases of ER in DCTA triplets treated using IFL [10,16,[44][45][46].…”

Section: Resultsmentioning

confidence: 99%

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Intrafetal Laser Therapy Is a Feasible Treatment for Different Fetal Conditions: A Systematic Review

et al. 2022

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Introduction: Over the past years, intrafetal laser (IFL) therapy has been increasingly used in the management of various prenatal conditions. The aim of our research is to clarify the effectiveness and safety of this technique. Methods: A systematic review of the literature was carried out using MEDLINE/PubMed over a period of 20 years (2001-2021). Results: A total of 41 articles were selected in the literature search, including 194 cases of twin reversed arterial perfusion (TRAP) sequence, 56 cases of bronchopulmonary sequestrations (BPS), 5 cases of placental chorioangiomas (PCA), 11 cases of sacrococcygeal teratoma (SCT), and 103 cases of embryo reduction (ER) managed using IFL. In TRAP sequence, perfusion of the acardiac twin was successfully disrupted in all cases. Preterm premature rupture of membranes (p-PROM) occurred in 6 out of 79 pregnancies (7.5%), and preterm birth (PTB) in 36 out of 122 pregnancies (29.5%). In BPS IFL was successfully performed in all cases with no significant complications. The rate of p-PROM and PTB were respectively 3.2% and 12.5%. All PCA IFL treated cases resulted in successful pregnancy outcomes; no cases of p-PROM were reported, but the rate of PTB reached a peak of 60% due to fetal complications. In SCT cases, complete cessation of blood flow was achieved in 4 patients (36.4%); p-PROM occurred in two cases (18.2%), whereas the rate of PTB was 87.5%. In ER no intraoperative or major maternal complications were described in the literature. Rates of miscarriage and PTB differed between initial trichorionic triamniotic and dichorionic triamniotic triplet pregnancies. Discussion: Our analysis suggests that IFL is a feasible technique for the management of different fetal conditions. However, the overall risk of PTB and its related morbidity and mortality, ranges from 12.5% in BPS to 87.5% in SCT. This could aid in decision making during prenatal counselling. However final perinatal outcome depends on the severity of the disease itself.

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Section: Resultsmentioning

confidence: 99%

“…In the five papers selected for meeting inclusion criteria [10,16,[44][45][46], we analyzed a total of 103 DCTA pregnancies managed by IFL-ER of one of the twins among the monochorionic pair (Table 5). The mean GA at diagnosis was 12.0 weeks (range: 8.0-14.0), whereas the mean GA at surgery was 13.1 weeks (range: 11.1-14.4).…”

Section: Embryo Reductionmentioning

confidence: 99%

Intrafetal Laser Therapy Is a Feasible Treatment for Different Fetal Conditions: A Systematic Review

et al. 2022

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“…Our study also agreed with Morlando et al (2021) who compared embryo reduction to conservative approaches in triplets and they concluded that better maternal and neonatal outcomes were found in women underwent embryo reduction. Moreover, little or no risks were associated with these procedure [20][21][22][23][24] .…”

Section: Discussionmentioning

confidence: 99%

Embryo Reduction to Twins (ERTT) Versus Cerclage in Triplets in Women with Normal Cervical Parameters: A Retrospective Study

Dawood

Soliman

Elshwaikh

et al. 2022

Evidence Based Women's Health Journal

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Objective: To compare the efficacy and safety of ERTT to cerclage in triplet pregnancy. Material and Methods: In this retrospective study, files of 266 patients were examined. Eligible patients managed by ERTT (n=120) were allocated into study group while patients managed by cerclage (n=121) were allocated into control group. Embryo reduction was done by oocyte aspiration needle before 10 th week. Cerclage was done at 14-16 weeks. Obstetrical and neonatal adverse outcomes were assessed in both groups. Results: One hundred and twenty cases were allocated in cerclage (control) group, 121 cases were allocated in ERTT (study) group. There was significant difference between both groups regarding abortion rate (P-value=0.002), delivery time (P-value=0.0001), gestational age at time of delivery (P-value=0.0001) and mode of delivery (P-value=0.0002). There was significant difference between both groups regarding fetal birth weight (P-value=0.0002), overall neonatal complications (P value 0.009) and need of NICU (P=value 0.0003). Conclusion:Embryo reduction to twins (ERTT) procedures improved obstetrical and neonatal outcomes in triplet pregnancies compared to conservative management with cerclage procedure.

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“…Y, aunque su tasa de supervivencia neonatal es comparable con la RFA aplicada antes de las 16 semanas, la incidencia de RPM antes de las 32 semanas de gestación de esta técnica es significativamente mayor (12) . La paciente permaneció hospitalizada hasta las 33 semanas 3 días y tuvo un parto pretérmino por cesárea electiva, complicación hallada por otros autores en estudios previos (7,8) . El recién nacido no presentó alteraciones neurológicas hasta el momento de su alta hospitalaria al 15° día.…”

Section: Discussionunclassified

“…Estas tienen por finalidad interrumpir el circuito vascular intergemelar evitando el aumento del gasto cardiaco del gemelo 'bomba'. Se informa que la rotura prematura de membranas (pRPM), el parto prematuro y la muerte intrauterina son las principales complicaciones de las terapias intrafetales (7,8) . La técnica óptima para tratar la secuencia TRAP todavía es motivo de debate.…”

Section: Introductionunclassified

Terapia laser intrafetal para la secuencia perfusión arterial inversa en gemelos (TRAP). Comunicación de un caso y revisión de la literatura

Tacchino

Híjar

Sesarego

et al. 2022

Rev peru ginecol obstet.

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Una primigesta de 41 años con gestación doble monocoriónica biamniótica, con diagnóstico de secuencia perfusión gemelar arterial reversa (TRAP, por sus siglas en inglés) y mal pronóstico perinatal fue intervenida mediante terapia laser intrafetal a las 18 semanas de gestación. Se complicó con rotura prematura de membranas que fue manejada en forma expectante hasta las 33 semanas 3 días, cuando se realizó cesárea electiva sin complicaciones. Se obtuvo un recién nacido vivo sano de 2,255 g que fue dado de alta hospitalaria el día 15 de nacido, sin complicaciones. Comunicamos el primer caso de terapia laser intrafetal realizado en nuestro país y resaltamos su eficacia, sencillez, bajo costo y abordaje ambulatorio en casos de secuencia TRAP.

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Expectant management versus multifetal pregnancy reduction in dichorionic triamniotic (DCTA) triplets: Single centre experience

Cited by 6 publications

References 22 publications

Intrafetal Laser Therapy Is a Feasible Treatment for Different Fetal Conditions: A Systematic Review

Intrafetal Laser Therapy Is a Feasible Treatment for Different Fetal Conditions: A Systematic Review

Embryo Reduction to Twins (ERTT) Versus Cerclage in Triplets in Women with Normal Cervical Parameters: A Retrospective Study

Terapia laser intrafetal para la secuencia perfusión arterial inversa en gemelos (TRAP). Comunicación de un caso y revisión de la literatura

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