Thermocoagulation for the Early Treatment of Pregnancy with an Acardiac Twin

Rodeck, Charles H.; Deans, Anne; Jauniaux, Eric

doi:10.1056/nejm199810293391805

Cited by 105 publications

(68 citation statements)

References 14 publications

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“…[2][3][4] The treatment options for acardiac twinning include expectant management, amniodrainage, and invasive treatment such as hysterotomy with selective delivery of the acardiac twin, intra-fetal ablation of the acardiac twin by alcohol, radiofrequency, laser or thermo-coagulation, ultrasoundguided funicular occlusion by ligation, intra-funicular embolization with foreign bodies, and fetoscopic umbilical cord occlusion by ligation, laser or thermocoagulation. [5][6][7][8][9][10][11][12][13][14][15] Invasive interventions have their own inherent risk and here we report successful treatment of an acardiac twin using ultrasound-guided intra-fetal ablation with alcohol in mid-trimester.…”

Section: Introductionmentioning

confidence: 77%

Intrafetal alcohol ablation of an acardiac twin

Zakaria

Ramli

Málek

et al. 2016

Int J Reprod Contracept Obstet Gynecol

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Section: Introductionmentioning

confidence: 77%

Intrafetal alcohol ablation of an acardiac twin

Zakaria

Ramli

Málek

et al. 2016

Int J Reprod Contracept Obstet Gynecol

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“…Expectant or interventional approach is to be determined by serial ultrasound and Doppler surveillance and echocardiography. 8 Prenatal intervention should be considered in large Acardiac twin, polyhydramnios, abnormal Doppler such as persistent absent or reversed diastolic flow in the umbilical artery, pulsatile flow in the umbilical vein and ductus venosus showing reversed flow, hydrops fetalis in donor twin and monochorionicmonoamniotic twins. The poly-hydraminos which is most commonly seen with this condition can be treated either by medications or by amnioreduction, definitive treatment modalities that cause occlusion of the perfused (acardiac) twin's cord or rudimentary aorta may be achieved by a variety of fetoscopic or ultrasound guided techniques (intrafetal laser ablation, radiofrequency thermal ablation and fetoscopic cord occlu sion with absolute alcohol, platinum coils, thermogenic coils).…”

Section: Discussionmentioning

confidence: 99%

Acardiac acephalus with malformed donor twin

Panchbudhe

Satia

Kambhampatti

2016

Int J Reprod Contracept Obstet Gynecol

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“…A recent modification of the bipolar forceps involves a built-in endoscope (Yamamoto et al, 2010). Meanwhile, monopolar needles (Rodeck et al, 1998) and radiofrequency energy using instruments as small as a 14 to 18 g needle were described (Lee et al, 2007;Moise et al, 2008).…”

Section: Myelomeningocoele and Other Open Fetal Surgical Proceduresmentioning

confidence: 99%

The making of fetal surgery

et al. 2010

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Fetal diagnosis prompts the question for fetal therapy in highly selected cases. Some conditions are suitable for in utero surgical intervention. This paper reviews historically important steps in the development of fetal surgery. The first invasive fetal intervention in 1963 was an intra-uterine blood transfusion. It took another 20 years to understand the pathophysiology of other candidate fetal conditions and to develop safe anaesthetic and surgical techniques before the team at the University of California at San Francisco performed its first urinary diversion through hysterotomy. This procedure would be abandoned as renal and pulmonary function could be just as effectively salvaged by ultrasound-guided insertion of a bladder shunt. Fetoscopy is another method for direct access to the feto-placental unit. It was historically used for fetal visualisation to guide biopsies or for vascular access but was also abandoned following the introduction of high-resolution ultrasound. Miniaturisation revived fetoscopy in the 1990s, since when it has been successfully used to operate on the placenta and umbilical cord. Today, it is also used in fetuses with congenital diaphragmatic hernia (CDH), in whom lung growth is triggered by percutaneous tracheal occlusion. It can also be used to diagnose and treat urinary obstruction. Many fetal interventions remain investigational but for a number of conditions randomised trials have established the role of in utero surgery, making fetal surgery a clinical reality in a number of fetal therapy programmes. The safety of fetal surgery is such that even non-lethal conditions, such as myelomeningocoele repair, are at this moment considered a potential indication. This, as well as fetal intervention for CDH, is currently being investigated in randomised trials.

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Thermocoagulation for the Early Treatment of Pregnancy with an Acardiac Twin

Cited by 105 publications

References 14 publications

Intrafetal alcohol ablation of an acardiac twin

Intrafetal alcohol ablation of an acardiac twin

Acardiac acephalus with malformed donor twin

The making of fetal surgery

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