Fetoscopic cord transection for treatment of monoamniotic twin reversed arterial perfusion sequence

Prefumo, Federico; Fichera, A.; Frusca, T.

doi:10.1002/uog.13229

Cited by 8 publications

(8 citation statements)

References 5 publications

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“…In the current literature the management of MOMA TRAP pregnancies is sparsely described and the reported rates of fetal demise up to 100% are concerning [8]. Only few case series report on the outcome of MOMA TRAP treated by intrauterine intervention mostly performed in the second trimester [8, 9, 11] (Table 2). The largest previously published series on six MOMA TRAP pregnancies treated by radiofrequency ablation in the second trimester reported a 66.7% survival rate [10].…”

Section: Discussionmentioning

confidence: 99%

“…The umbilical cord was transected in contact mode with the bare tip of the laser fiber. After 2017, a 3-Fr grasping forceps was used in addition to the laser fiber in order to allow controlled manipulation of the umbilical cord during the procedure [9, 13]. Choice and timing of the intervention were decided on an individual basis after discussion with the patient and taking into consideration individual risk factors.…”

Section: Methodsmentioning

confidence: 99%

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Outcome of Monochorionic Monoamniotic Twin Reversed Arterial Perfusion Sequence Diagnosed in the First Trimester

et al. 2021

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Introduction: The aim of this study is to evaluate the outcome of pregnancies complicated by monochorionic monoamniotic twin reversed arterial perfusion sequence (MOMA TRAP) diagnosed in the first trimester. Methods: All patients diagnosed with MOMA TRAP sequence <14.0 weeks of gestation in a 10-year study period were retrospectively analyzed for intrauterine course and outcome. All patients were offered either expectant management or intrauterine intervention. Adverse outcome was defined as either intrauterine death (IUD), neonatal death or preterm birth <34.0 weeks of gestation. Results: In the study period, 17 cases with MOMA TRAP sequence were diagnosed. Of these, 2 couples opted for termination of pregnancy. The remaining 15 were divided into 2 groups depending on the management: group A (n = 8) with expectant management and group B (n = 7) with intrauterine intervention. All fetuses in group A died before 20 weeks. Survival in group B was significantly better with 4/7 (57.1%) life births at a median of 39.6 weeks of gestation (p = 0.0256). The reasons for IUD in the 3 cases in group B were hemodynamic, strangulation, and bleeding complications during intervention. Conclusions: Intrauterine intervention in MOMA TRAP pregnancies significantly improves neonatal survival, although it is still associated with a substantial risk for IUD by hemodynamic complications or entanglement.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Outcome of Monochorionic Monoamniotic Twin Reversed Arterial Perfusion Sequence Diagnosed in the First Trimester

et al. 2021

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“…COT was adopted in monochorionic monoamniotic (MCMA) pregnancies at risk of cord entanglement. 5 In all remaining cases in which fetal therapy was indicated, IFL was performed. Under ultrasound guidance, an 18‐gauge needle was inserted with a free‐hand technique in the pelvis of the acardiac twin, very close to the intra‐abdominal portion of the feeding vessels (umbilical artery and vein in proximity of the hilum); then, a 600‐μm laser fiber was inserted into the needle and advanced a few millimeters in front of the needle tip.…”

Section: Methodsmentioning

confidence: 99%

Timing of intra‐fetal laser therapy for twin reversed arterial perfusion (TRAP) sequence: Retrospective series and systematic review and meta‐analysis

Vitucci

Fratelli

Fichera

et al. 2022

Intl J Gynecology & Obste

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Objective To estimate the neonatal survival rate after intra‐fetal laser (IFL) treatment for twin reversed arterial perfusion (TRAP) sequence, and to investigate the effect of gestational age at the time of procedure. Methods Retrospective cohort study of TRAP sequences followed at our institution from 2013–2020. Systematic review and meta‐analysis of the neonatal survival rate after IFL was conducted. Both diamniotic and monoamniotic monochorionic pregnancies were included. A subgroup analysis to compare outcomes according to gestational age at procedure (<16+0 weeks or ≥16+0 weeks) was planned. Results Thirteen pregnancies were followed at our center and seven were treated with IFL: the survival rate was 57%. Ten studies published between 2008 and 2020 for a total of 156 cases were included in the meta‐analysis. The overall neonatal survival after IFL was 79% (95% CI 0.72–0.86, I2 22%). A random‐effects model comparing neonatal survival for IFL performed <16+0 weeks versus ≥16+0 weeks showed no significant difference between the two groups (OR = 0.93; 95% CI 0.37–2.33). Conclusion IFL is a safe and minimally invasive technique for the treatment of TRAP sequence, with a survival rate of 79%. Gestational age at treatment (before or after 16 weeks) does not seem to affect neonatal survival rate.

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“…Coagulation of the umbilical cord allowed for later cord transection in the area of narrowed cord which separated the acranial triplet, thereby increasing the efficacy of the miniature scissors and decreasing future entanglement morbidity. This is important because the risk of cord entanglement as the etiology for future fetal morbidity and mortality does not resolve even following selective reduction [6,7]. Middeldorp et al [6] describe a successful cord transection utilizing a contact laser to reduce future cord occlusion morbidity.…”

Section: Discussionmentioning

confidence: 99%

Disentanglement of Discordant Monochorionic-Monoamniotic Twins in a Triplet Pregnancy: An Innovative Approach Utilizing Fetoscopic Laser Coagulation with Micro-Laparoscopic Scissor Dissection

Kunzier

Allaf²,

Chavez³

et al. 2015

Fetal Diagn Ther

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Triplet gestations are associated with high perinatal morbidity. Dichorionic-diamniotic triplet pregnancies with growth discordance, polyhydramnios and structural anomalies carry a significantly increased risk of fetal morbidity and mortality from the baseline risks of high-order multiple pregnancies. Intrauterine fetal death of one fetus of a monochorionic pregnancy may cause neurological injury to the surviving fetus. We present a case where an innovative technique was created combining use of the fetoscopic laser and miniature laparoscopic instruments to selectively reduce and disentangle the umbilical cord of the acranial growth-restricted fetus from the structurally normal fetus's umbilical cord in a dichorionic-diamniotic triplet pregnancy.

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Fetoscopic cord transection for treatment of monoamniotic twin reversed arterial perfusion sequence

Cited by 8 publications

References 5 publications

Outcome of Monochorionic Monoamniotic Twin Reversed Arterial Perfusion Sequence Diagnosed in the First Trimester

Outcome of Monochorionic Monoamniotic Twin Reversed Arterial Perfusion Sequence Diagnosed in the First Trimester

Timing of intra‐fetal laser therapy for twin reversed arterial perfusion (TRAP) sequence: Retrospective series and systematic review and meta‐analysis

Disentanglement of Discordant Monochorionic-Monoamniotic Twins in a Triplet Pregnancy: An Innovative Approach Utilizing Fetoscopic Laser Coagulation with Micro-Laparoscopic Scissor Dissection

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