Impact of laser coagulation in severe twin–twin transfusion syndrome on fetal Doppler indices and venous blood flow volume

Gratacós, E.; Schoubroeck, Dominique Van; Carreras, Elena; Devlieger, Roland; Romá, Eva; Cabero, L.; Deprest, Jan

doi:10.1046/j.1469-0705.2002.00749.x

Cited by 85 publications

(107 citation statements)

References 21 publications

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“…For comparison, control twins were identified as the smaller twin (smaller) or the larger twin (larger). In cases of TTTS, the ratio of intertwin UVVF could be altered by significant intertwin transfusion (Gratacos et al, 2002;Ishii et al, 2007;Yamamoto et al, 2007). As a result, pregnancies with signs of TTTS, as defined by severe oligohydramnios in one twin (maximum vertical pocket of amniotic fluid, < 2 cm) and polyhydramnios in another twin (maximum vertical pocket, > 8 cm) (Quintero et al, 1999), were not included in this study.…”

Section: Methodsmentioning

confidence: 99%

The Relationships of Umbilical Venous Volume Flow, Birthweight and Placental Share in Monochorionic Twin Pregnancies With and Without Selective Intrauterine Growth Restriction

Chang¹,

Chang

Chao

et al. 2011

Twin Res Hum Genet

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This study was conducted to investigate the relationship among umbilical venous volume flow, birthweight and placental share in monochorionic twins with or without selective growth restriction. Having excluded cases complicated with twin-to-twin transfusion syndrome and one co-twin suffering intrauterine fetal death, a total of 51 monochorionic twin pregnancies were divided into two groups as with (group 1) and without (group 2) selective intrauterine growth restriction. Umbilical venous volume flow was calculated by multiplying the umbilical vein cross-sectional area by half of the maximal velocity around mid-trimester. The placentas were cut along the vascular equator into two individual placental masses. The discordance of birthweight was calculated as [(birthweight of larger twin—birthweight of smaller twin)/birthweight of larger twin 100%]. The discordances of umbilical venous volume flow and placental share were calculated in a similar fashion. The median umbilical venous volume flow discordances (68.4% and 15.3% in groups 1 and 2 monochorionic twins, respectively) were similar and correlated well with the placental share discordances (66.6% and 18.5% in groups 1 and 2 monochorionic twins, respectively) but not with the birthweight discordance (28.6% and 6.4% in groups 1 and 2 monochorionic twins, respectively) in both groups. We concluded that the umbilical venous volume flow discordance reflects the placental share discordance rather than the birthweight discordance in monochorionic twin pregnancies.

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Section: Methodsmentioning

confidence: 99%

The Relationships of Umbilical Venous Volume Flow, Birthweight and Placental Share in Monochorionic Twin Pregnancies With and Without Selective Intrauterine Growth Restriction

Chang¹,

Chang

Chao

et al. 2011

Twin Res Hum Genet

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“…In contrast, donors may show transient signs of relative hypervolemia reflected by an increase in umbilical vein flow, DV-PI [37,97], tricuspid regurgitation [37], and even hydrops [97] that usually regresses within 4 weeks [37]. …”

Section: Research and Clinical Applications Of Fetal Cardiac Functionmentioning

confidence: 99%

“…Most changes are described in the recipient, in which volume and pressure overload lead to cardiomegaly and hypertrophy, usually with impaired relaxation but preserved systolic function [96]. Volume overload is reflected by increased umbilical blood flow [97,98] and ductus venosus pulsatility [37,95,96], tricuspid and mitral insufficiency, cardiomegaly [95,96,99,100], and increased levels of ANP and BNP [37,101]. Pressure overload leads to cardiac hypertrophy in more than half of recipients [95,96,100,102], usually with an increase in ejection fraction [96,99].…”

Section: Research and Clinical Applications Of Fetal Cardiac Functionmentioning

confidence: 99%

“…Treatment based on coagulation of placental anastomosis by fetoscopy improves cardiac function in recipients as measured by a decrease in DV-PI [37,97], MPI, and the presence of tricuspid regurgitation and EA fusion [37,96]. In contrast, donors may show transient signs of relative hypervolemia reflected by an increase in umbilical vein flow, DV-PI [37,97], tricuspid regurgitation [37], and even hydrops [97] that usually regresses within 4 weeks [37].…”

Section: Research and Clinical Applications Of Fetal Cardiac Functionmentioning

confidence: 99%

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Fetal Cardiac Function: Technical Considerations and Potential Research and Clinical Applications

2012

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Fetal echocardiography was initially used to detect structural anomalies but has more recently also been proposed to assess fetal cardiac function. This review summarizes technical issues and limitations in fetal cardiac function evaluation, as well as its potential research and clinical applications. Functional echocardiography has been demonstrated to select high-risk populations and to be associated with outcome in several fetal conditions including intrauterine growth restriction, twin-to-twin transfusion syndrome, maternal diabetes, and congenital diaphragmatic hernia. Fetal heart evaluation is challenging due to the smallness and high heart rate of the fetus and restricted access to the fetus far from the transducer. Due to these limitations and differences in cardiac function which are related to fetal maturation, cardiovascular parameters should be validated in the fetus and used with caution. Despite these precautions, in expert hands and with appropriate ultrasound equipment, evaluation of cardiac function is feasible in most fetuses. Functional fetal echocardiography is a promising tool that may soon be incorporated into clinical practice. Research is warranted to further refine the contribution of fetal cardiac assessment to the diagnosis, monitoring, or prediction of outcomes in various fetal conditions.

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“…La presencia de Aa-v, no compensada por Aa-a protectora (7), ante diferencia de presión intraplacentaria, origina transfusión unidireccional, de mal pronóstico perinatal y su expresión máxima es el Síndrome de Transfusión Gemelo-Gemelo (STGG) grave, presente en 15% de los casos y que tiene evolución letal (8,9).…”

Section: Introductionunclassified

Vía Del Nacimiento en Gemelar Monocoriónico Con Transfusión Intergemelar Y Terapia in Utero

2004

Rev. chil. obstet. ginecol.

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RESUMENEl propósito de la comunicación es revisar la vía del parto en embarazo gemelar complicado por Síndrome de Transfusión Gemelo-Gemelo (STGG) y por gemelo acardio con perfusión arterial reversa. La placentación del gemelar monocoriónico por sus anastomosis arteriales y venosas genera esas complicaciones que se asocian a una mortalidad cercana a 100% cuando no son tratadas en el período antenatal. Se describen dos casos de gemelar monocoriónico complicado, uno con STGG y otro, un acardio con perfusión reversa, ambos con diagnóstico ultrasónico precoz en primer trimestre y comienzo del segundo, que fueron exitosamente tratados in útero con coagulación láser sobre anastomosis vascular placentaria y sobre arteria umbilical pelviana obteniendo mejoría hemodinámica y recuperación de la funcionalidad placentaria. Se discuten aspectos generales del cuidado médico antenatal e intraparto del embarazo gemelar y específicamente del gemelar monocoriónico complicado. Se concluye que la terapia in útero fue exitosa además de mejorar el pronóstico puede favorecer la vía vaginal de parto.PALABRAS CLAVE: embarazo gemelar monocoriónico, anastomosis vasculares, terapia láser, parto vaginal SUMMARYThe aim of this communication is to review the way of delivering twin pregnancy complicated by either Twin to Twin Transfusion Syndrome (TTTS) or acardic twin with reverse arterial perfusion. The monochorionic placentae is characterised by superficial or deep vascular anastomosis which leads to the complications mentioned above, which are associated with almost 100% mortality when they are not treated antenatally. We describe two cases of severe TTTS and acardic twin with reverse arterial perfusion both diagnosed antenatally during the first and early second trimester of pregnancy on which laser treatment either on placental vascular anastomoses or pelvic single umbilical artery were done successfully. In addition of this we discuss some clinical aspects of prevention of premature delivery, antenatal and intrapartum medical care for twin pregnancy in general and specifically for complicated monochorionic twin pregnancy. We conclude that a successful fetal therapy improves pregnancy prognosis and makes possible vaginal delivery.

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Impact of laser coagulation in severe twin–twin transfusion syndrome on fetal Doppler indices and venous blood flow volume

Cited by 85 publications

References 21 publications

The Relationships of Umbilical Venous Volume Flow, Birthweight and Placental Share in Monochorionic Twin Pregnancies With and Without Selective Intrauterine Growth Restriction

The Relationships of Umbilical Venous Volume Flow, Birthweight and Placental Share in Monochorionic Twin Pregnancies With and Without Selective Intrauterine Growth Restriction

Fetal Cardiac Function: Technical Considerations and Potential Research and Clinical Applications

Vía Del Nacimiento en Gemelar Monocoriónico Con Transfusión Intergemelar Y Terapia in Utero

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