Survival Rate without Brain Abnormalities on Postnatal Ultrasonography among Monochorionic Twins after Fetoscopic Laser Photocoagulation for Selective Intrauterine Growth Restriction with Concomitant Oligohydramnios

Ishii, Keisuke; Wada, Seiji; Takano, Mayumi; Nakata, Masahiko; Murakoshi, Takeshi; Sago, Haruhiko

doi:10.1159/000486130

Cited by 16 publications

(14 citation statements)

References 26 publications

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“…Fetoscopic laser surgery is one option for managing severe selective FGR . Ishii et al reported that conservative observational management resulted in unfavorable outcomes if the smaller fetus had both oligohydramnios and abnormal UA Doppler waveforms.…”

Section: Discussionmentioning

confidence: 99%

Successful use of fetoscopic laser surgery as treatment for a monochorionic‐triamniotic triplet pregnancy complicated by twin‐reversed arterial perfusion sequence and severe selective fetal growth restriction: A case report

Takano

Nakata

Rikitake

et al. 2019

J of Obstet and Gynaecol

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Monochorionic triplet pregnancy is a rare condition, and twin-reversed arterial perfusion (TRAP) sequence and severe selective fetal growth restriction (FGR) are associated with high perinatal morbidity and mortality rates. We report a case of TRAP sequence and selective FGR typeIIconcurrently complicating a monochorionic triplet pregnancy. Fetoscopic laser surgery (FLS) was performed at 16 + 1 weeks of gestation and was technically successful. Inter-fetus placental anastomoses were coagulated. The pregnancy continued until 28 + 4 weeks of gestation, when the patient presented with preterm rupture of membranes and preterm labor. Two live female newborns were delivered by a cesarean section, and their postnatal course of the neonates was uneventful and in accordance with their gestational age at birth. To our knowledge, this is the first case report of FLS resulting in favorable outcomes for a monochorionic triplet pregnancy concurrently complicated with TRAP sequence and selective FGR type II.

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Section: Discussionmentioning

confidence: 99%

Successful use of fetoscopic laser surgery as treatment for a monochorionic‐triamniotic triplet pregnancy complicated by twin‐reversed arterial perfusion sequence and severe selective fetal growth restriction: A case report

Takano

Nakata

Rikitake

et al. 2019

J of Obstet and Gynaecol

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“…Adverse outcome was defined as the occurrence of IUFD. The definitions of TTTS, sIUGR, and TAPS are described in the Appendix (Tables ) as per the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) practice guidelines . Discordant ratio of birth weight (DRBW) was defined with two live births, calculated using the following formula: ([larger BW−smaller BW]/larger BW) × 100% as described by Hartley et al The prevalence of DRBW more than 25% (BWD 25%) was confirmed.…”

Section: Methodsmentioning

confidence: 99%

Impact of first trimester determination of abnormal cord insertion on twin‐to‐twin transfusion syndrome and other adverse outcomes in monochorionic diamniotic twins: A retrospective cohort study

et al. 2020

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Objective To assess the influence of abnormal cord insertion (CI) detected by first trimester ultrasonography on the development of twin‐to‐twin transfusion syndrome (TTTS) in monochorionic diamniotic (MCDA) twins. Method In this retrospective cohort study, consecutive patients with MCDA twins who underwent fetal ultrasound screening in the first trimester between January 2011 and January 2017 were enrolled. The CI sites were evaluated between 11 + 0 and 13 + 6 weeks' gestation. All twin pairs were assigned to the abnormal CI group (twin pair with velamentous cord insertion (VCI) and/or marginal cord insertion (MCI) in one or both twins) or the normal CI group (twin pair with both normal CI). The relationships of adverse outcomes in two groups were analyzed. Results A total of 109 MCDA twin pairs were examined; 15 cases were classified into the abnormal CI group and 94 cases into the normal CI group. The incidence of TTTS was significantly higher in the abnormal than in the normal CI group (26.7% vs 7.45%, P = .04). In patients who developed TTTS, all donors had VCI. Conclusion Ultrasound evaluation of abnormal CI at 11 + 0 to 13 + 6 weeks' gestation in MCDA twins is valuable in the assessment of the risk for TTTS.

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“…Several studies have shown the application of FLS for sIUGR with absent or reverse end-diastolic velocity (AREDV) in the umbilical artery (UA) [30][31][32]. FLS may be a promising treatment option for sIUGR when accompanied by both AREDV in UA and severe oligohydramnios of IUGR twins [33,34]. Oligohydramnios in the IUGR twin may be an essential indication for FLP for sIUGR.…”

Section: Fetoscopic Laser Surgerymentioning

confidence: 99%

Fetal therapies as standard prenatal care in Japan

Sago

Wada

2020

Obstet Gynecol Sci

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With recent advances in fetal medicine, various attempts have been made to save fetuses facing perinatal death or devastating consequences despite optimal management after birth. The concept of the fetus as a patient has been established through the application of in utero treatments. This paper reviews fetal therapies in order to highlight the role of perinatal medicine as standard prenatal care. Fetal therapies consist of medical therapy, percutaneous ultrasound-guided surgery, fetoscopic surgery, and open fetal surgery. In the 1980s, with advances in ultrasound imaging, percutaneous ultrasound-guided surgeries such as vesicoamniotic shunting for lower urinary tract obstruction and thoracoamniotic shunting (TAS) for fetal hydrothorax (FHT) were started. In the 1990s, fetoscopic laser surgery (FLS) for twin-twin transfusion syndrome (TTTS) was introduced, and later, a fetoscopic approach for congenital diaphragmatic hernia was also established. The revival of open fetal surgery, introduced in the 1980s by pediatric surgeons, began in the 2010s after a successful clinical study for myelomeningocele. Although many fetal therapies are still considered experimental, some have proven effective, such as FLS for TTTS, TAS for primary FHT, and radiofrequency ablation (RFA) for twin reversed arterial perfusion (TRAP) sequence. These three fetal therapies have been approved for coverage by Japan National Health Insurance as a result of clinical studies performed in Japan. FLS for TTTS, TAS for primary FHT, and RFA for TRAP sequence have become standard prenatal care approaches in Japan. These three minimally invasive fetal therapies will help improve the perinatal outcomes of fetuses with these disorders.

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Survival Rate without Brain Abnormalities on Postnatal Ultrasonography among Monochorionic Twins after Fetoscopic Laser Photocoagulation for Selective Intrauterine Growth Restriction with Concomitant Oligohydramnios

Cited by 16 publications

References 26 publications

Successful use of fetoscopic laser surgery as treatment for a monochorionic‐triamniotic triplet pregnancy complicated by twin‐reversed arterial perfusion sequence and severe selective fetal growth restriction: A case report

Successful use of fetoscopic laser surgery as treatment for a monochorionic‐triamniotic triplet pregnancy complicated by twin‐reversed arterial perfusion sequence and severe selective fetal growth restriction: A case report

Impact of first trimester determination of abnormal cord insertion on twin‐to‐twin transfusion syndrome and other adverse outcomes in monochorionic diamniotic twins: A retrospective cohort study

Fetal therapies as standard prenatal care in Japan

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