Transient hydropic signs in the donor fetus after fetoscopic laser coagulation in severe twin–twin transfusion syndrome: incidence and clinical relevance

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

doi:10.1046/j.1469-0705.2002.00642.x

Cited by 52 publications

(48 citation statements)

References 16 publications

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“…It has been shown that although the majority of cardiovascular perturbations will improve within days to weeks of therapy and ultimately resolve, 516 some will not and the hemodynamic condition of either fetus may suddenly worsen. 517,518 Therefore, although experience is thus far limited, fetal echocardiography for surviving twins should be considered at 24 to 48 hours after the procedure with additional follow-up dictated by clinical findings thereafter.…”

Section: Diagnosis and Hemodynamic Assessmentmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

1,016

543

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Background— The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results— A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions— Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

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Section: Diagnosis and Hemodynamic Assessmentmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

1,016

543

View full text Add to dashboard Cite

show abstract

“…In 1999, Quintero et al [8] proposed a staging system that has been adopted by many [4,[9][10][11][12], sometimes with minor modifications [13,14]. According to this staging system (table 1), severe TTTS can be further characterized accord-Luks/Carr/Plevyak/Craigo/Athanassiou/ Ralston/Tracy Critically abnormal Doppler studies are defined as absent/ reversed end-diastolic velocity in the umbilical artery, reversal of flow in the ductus venosus, or pulsatile flow in the umbilical vein.…”

Section: Introductionmentioning

confidence: 99%

Limited Prognostic Value of a Staging System for Twin-to-Twin Transfusion Syndrome

et al. 2004

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Objective: Severe twin-to-twin transfusion syndrome (TTTS) is usually classified according to a staging system (I–V) based on ultrasonographic findings of polyhydramnios in the recipient, oligohydramnios in the donor, the presence or absence of the donor’s bladder, Doppler waveform changes and (impending) hydrops. Stage correlates with the severity of disease, and it is assumed that, without intervention, severe TTTS will evolve in succession from stage I to stage V (fetal demise). However, this progression has not been validated in longitudinal studies. Herein, we report on the natural progression of severe TTTS in a cohort of patients from a regional Fetal Treatment Program. Methods: Eighteen patients with severe TTTS, diagnosed between 15 and 25 weeks of gestation, were managed over a 28-month period. Data were collected until delivery, endoscopic surgical intervention or dual fetal demise. Patients were evaluated at least once a week. Stage, estimated fetal weight, percent recipient/donor body weight discordance and survival were recorded. Results: The present study represents a total follow-up of 108 patient-weeks. Of 90 week-to-week evaluations, 65 showed no change in stage; 11 showed downstaging (by more than 1 stage in 3, or 27%), and 13 showed upstaging (by more than 1 stage in 8, or 62%). Nine patients (all stage II or above) underwent endoscopic laser ablation. Overall survival was 67%, and survival of at least 1 twin occurred in 78% of pregnancies. Weight discordance between the donor and recipient did not predict outcome. Conclusion: The current staging system for severe TTTS may not be helpful in predicting the direction, degree or speed of progression of the condition. Indications for intervention should remain stage-related, and not based on projected progression.

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“…Occasionally, transient hydrops typically with small pleural effusion and slight skin edema could be seen in the donor few days after FLP (Figure 7). Gratacos and co-workers show 27% of donors after FLP developed one or more hydropic signs, and 90% of these were mild or moderate and transient (3-4 days); there was no intrauterine fetal demise of transient hydropic donor [31]. Transient hydrops may develop in a proportion of donor fetuses after FLP for severe TTTS, which is not associated with a poor prognosis.…”

Section: Ultrasound Findings After Fetoscopic Laser Photocoagulationmentioning

confidence: 90%

Fetoscopic laser photocoagulation of communicating vessels for severe twin–twin transfusion syndrome

Murakoshi

Shinno

Shiojima

et al. 2006

The Ultrasound Review of Obstetrics & Gynecology

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Twin-twin transfusion syndrome (TTTS) is still one of the most challenging diseases of monochorionic twin pregnancies. The advent of ultrasonography revealed detailed of pathophysiology of the disease in utero, therefore we can be made aware of a new strategy to manage TTTS. Recently after randomized clinical trial, selective fetoscopic laser photocoagulation of communicating vessels (FLP) seems to become the optimal treatment for severe early onset TTTS, however, questions still remain for short-and long-term neurological and cardiovascular outcomes. To diagnose and manage TTTS favorably, it is quite important to have accurate diagnosis of chorionicity and amnionicity, fetal echocardiography including various Doppler studies, and the staging system of TTTS.

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Transient hydropic signs in the donor fetus after fetoscopic laser coagulation in severe twin–twin transfusion syndrome: incidence and clinical relevance

Cited by 52 publications

References 16 publications

Diagnosis and Treatment of Fetal Cardiac Disease

Diagnosis and Treatment of Fetal Cardiac Disease

Limited Prognostic Value of a Staging System for Twin-to-Twin Transfusion Syndrome

Fetoscopic laser photocoagulation of communicating vessels for severe twin–twin transfusion syndrome

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