Modern view on predicting outcomes after fetoscopic laser coagulation of placental anastomoses in polyuria-oliguria syndrome (review)

Abstract

The purpose of this literature review is to analyze the results of fetoscopic laser photocoagulation of placental anastomoses, obtained in various studies published in foreign and domestic medical publications in recent years.Materials and methods. The review included published data over the last 10 years. The literature search was conducted in Medline, Scopus, Web of Science, Google Scholar, PubMed, Wiley and Cochrane Library databases.Result. As a result of the analysis, the main ultrasound and fetoscopic markers influencing the outcome of the surgical treatment were determined: the location of the placenta on the anterior and posterior walls, the location of the umbilical cord attachment, the number of placental anastomoses; abnormal graphs of blood flow rates in the umbilical cord arteries; the distance between the attachment points of the umbilical cord; dissociated growth of the fetuses; the duration of gestation and the stage of severity of twin-to-twin transfusion syndrome, as measured with the R. Quintero staging system, at the time of the operation; the experience of the operating surgeons; and the duration of the operation.Conclusion. Analysis of the literature data has shown that these markers are extremely unreliable in predicting the chances of survival for one or both fetuses. Further study of ultra-sound and fetoscopy predictors of adverse outcome of laser photocoagulation of placental anastomoses will allow for a more balanced approach to the choice of surgical tactics and personalized consultations with patients.