North American Fetal Therapy Network: intervention vs expectant management for stage I twin-twin transfusion syndrome

Emery, Stephen P.; Hasley, Steve; Catov, Janet M.; Miller, Russell S.; Moon-Grady, Anita J.; Baschat, Ahmet; Johnson, Anthony; Lim, Foong Yen; Gagnon, Alain; O’Shaughnessy, R.; Özcan, Tülin; Luks, François I.

doi:10.1016/j.ajog.2016.04.024

Cited by 56 publications

(48 citation statements)

References 12 publications

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“…Os principais desafios para o tratamento da STFF na atualidade incluem dúvidas quanto ao benefício da fotocoagulação das anastomoses no estágio I de Quintero 23 , uma vez que há a possibilidade de estabilização ou resolução espontânea do quadro, e a redução nos riscos de parto prematuro e sequelas neurológicas dos fetos que sobrevivem após a cirurgia.…”

Section: Principais Procedimentos Cirúrgicos Fetais I) Fotocoagulaçãounclassified

Cirurgia fetal no contexto atual

Rocha

Filho

Bunduki

et al. 2018

Rev. Med. (São Paulo)

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RESUMO:A cirurgia fetal é, hoje, uma realidade em grandes centros especializados na área da medicina fetal. Surgiu por volta da década de 1960, inicialmente atrelada à necessidade de melhor conhecer e entender as patologias fetais, e teve desenvolvimento exponencial impulsionado pelo aprimoramento das técnicas diagnósticas pré-natais. Foi aos poucos se consolidando e tornando-se o tratamento de escolha para algumas patologias específicas, mudando definitivamente o curso dessas doenças. Nesse estudo, encontra-se um breve histórico das cirurgias fetais mais comumente realizadas em todo o mundo, como elas surgiram e como foram evoluindo com o passar do tempo, os principais estudos que as validaram e a técnica cirúrgica mais amplamente utilizada em cada caso. Entre as principais cirurgias, são citadas a fotocoagulação a laser de anastomoses placentárias na síndrome de transfusão feto-fetal, a correção intrauterina a céu aberto da mielomeningocele fetal e a oclusão endotraqueal fetal por balão nos casos de hérnia diafragmática congênita. Também são abordados cirurgias e procedimentos cujos benefícios são menos evidentes e os resultados ainda um tanto controversos, como as intervenções urinárias nos casos de obstrução ao trato urinário inferior, procedimentos cardíacos em casos de estenose aórtica crítica, derivações tóracoamnióticas para tratamento de derrames pleurais compressivos, além de ressecções intrauterinas de teratomas sacrococcígeos e de massas pulmonares. Também é feita uma avaliação a respeito do futuro da cirurgia fetal.Descritores: Feto/cirurgia; Fetoscopia. ABSTRACT:Fetal surgery is now a reality in large centers that specialize in the field of fetal medicine. Fetal surgery emerged in the 1960s, primarily from the need to better identify and understand fetal pathologies, and its exponential development was driven by improvements in prenatal diagnostic techniques. Fetal surgery gradually became the main treatment for specific fetal pathologies, changing the course of these diseases. This study summarizes the history of the fetal surgeries that are most commonly performed worldwide, how they started and how they evolved over time, the main validation trials and the most widely used surgical technique in each case. The main surgeries include laser photocoagulation of placental anastomoses in twin-to-twin transfusion syndrome, in utero repair of fetal myelomeningocele and fetal endotracheal occlusion in cases of congenital diaphragmatic hernia. Other surgeries and procedures, whose benefits are less clear and whose results are still somewhat controversial, such as urinary interventions in cases of lower urinary tract obstruction, cardiac procedures in cases of critical aortic stenosis, thoracoamniotic shunts for the treatment of massive pleural effusions and intrauterine resection of sacrococcygeal teratomas and pulmonary masses, are also cited. The future of fetal surgery is also assessed.

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Section: Principais Procedimentos Cirúrgicos Fetais I) Fotocoagulaçãounclassified

Cirurgia fetal no contexto atual

Rocha

Filho

Bunduki

et al. 2018

Rev. Med. (São Paulo)

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“…Two studies published in 2016 complicated the field even further: An Australian report on 43 cases of stage 1 TTTS shows that the disease can remain stable or regress in up to 59% of cases, suggesting that conservative management would be an acceptable option. On the other hand, the North Atlantic Fetal Therapy Network (Naftnet) showed in a retrospective cohort of 124 cases that 60% progress and that fetoscopic laser ablation of the placental vascular anastomoses has the potential to reduce adverse outcomes. Both studies nevertheless agreed on the fact that stage 1 TTTS still has a high risk of fetal or neonatal mortality (20–23%) and therefore support the currently ongoing TTTS stage 1 trial, which is randomizing patients between expectant management and laser and should be nearing completion soon (http://www.clinicaltrials.gov – NCT01220011).…”

Section: Advances In Invasive Fetal Therapymentioning

confidence: 99%

In case you missed it: thePrenatal Diagnosiseditors bring you the most significant advances of 2016

et al. 2017

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“…Twin‐twin transfusion syndrome (TTTS) is a condition that affects monochorionic multiple gestations when placental vascular anastomoses cause the transfer of blood from one twin (donor) to the other (recipient) . Untreated TTTS is associated with substantial risk for perinatal death, preterm birth, and neurological impairment among survivors . The risk of such poor outcomes has led to development of various treatment modalities, including amnioreduction, selective feticide, and selective laser photocoagulation of the communicating vessels (SLPCV).…”

Section: Introductionmentioning

confidence: 99%

Characteristics of referred patients with twin‐twin transfusion syndrome who did not undergo fetal therapy

et al. 2019

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Introduction Abundant research has reported twin‐twin transfusion syndrome (TTTS) outcomes following fetal therapy. Our research describes TTTS patients who did not undergo fetal therapy. Methods Records from TTTS pregnancies evaluated at 16 to 26 gestational weeks were reviewed between January 2006 and March 2017. The study population comprised subjects who did not undergo fetal therapy. Based on initial consultation, patients were grouped as nonsurgical vs surgical candidates. TTTS progression and perinatal outcomes were assessed. Results Of 734 TTTS patients evaluated, 68 (9.3%) did not undergo intervention. Of these, 62% were nonsurgical candidates and 38% were surgical candidates. Nonsurgical candidates were ineligible for treatment because of fetal demise or maternal factors (placental abruption, severe membrane separation, and preterm labor). Of surgical candidates, 11 underwent expectant management, eight elected pregnancy termination, and seven planned fetal intervention but had a complication before the procedure. TTTS progression occurred in 10 (15.2%) of 66 cases. Neonatal survival in 64 cases was as follows: in 41 (64%), no survivors; in 11 (17.2%), one survivor; and in 12 (18.8%), two survivors. Conclusion Nine percent of referred TTTS patients did not undergo fetal therapy, with many ineligible because of morbidity between referral and consultation. Studies of TTTS should acknowledge this subgroup and circumstances leading to lack of treatment.

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North American Fetal Therapy Network: intervention vs expectant management for stage I twin-twin transfusion syndrome

Cited by 56 publications

References 12 publications

Cirurgia fetal no contexto atual

Cirurgia fetal no contexto atual

In case you missed it: thePrenatal Diagnosiseditors bring you the most significant advances of 2016

Characteristics of referred patients with twin‐twin transfusion syndrome who did not undergo fetal therapy

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