Umbilical-Cord Ligation of an Acardiac Twin by Fetoscopy at 19 Weeks of Gestation

Quintero, Rubén A.; Reich, Harry; Puder, Karoline S.; Bardicef, Mordechai; Evans, Mark I.; Cotton, David B.; Romero, Roberto

doi:10.1056/nejm199402173300705

Cited by 187 publications

(71 citation statements)

References 9 publications

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“…In the past 3 decades, several methods for intrauterine intervention have been developed, aiming to improve the outcome for the pump twin [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75]. Most studies in the literature have reported treatment in 1-10 cases, with only a handful examining larger series.…”

Section: Discussionmentioning

confidence: 99%

Optimal Method and Timing of Intrauterine Intervention in Twin Reversed Arterial Perfusion Sequence: Case Study and Meta-Analysis

et al. 2014

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Introduction: The objective of this study was to define the optimal method and timing of intervention in twin reversed arterial perfusion (TRAP) sequence. Material and Methods: During a period of 20 years (1993-2013), we performed endoscopic laser coagulation of umbilical cord vessels or intrafetal laser in 67 pregnancies with TRAP sequence. These data were combined with those reported in the literature to determine the survival rate of the pump twin for different methods and timing of interventions. Results: A variety of techniques were used to interrupt the blood supply to the acardiac twin. Most procedures were performed at or after 16 weeks, and with most methods the survival rate of the pump twin was about 80%. Good results were also obtained for triplet pregnancies. In 18 of 30 cases (60%) diagnosed at 11-14 weeks, there was spontaneous cessation of flow in the acardiac twin before planned intervention at 16-18 weeks, and in 11 of these (61.1%) the pump twin died or suffered brain damage. In 103 pregnancies treated by intrafetal laser at 12-27 weeks, there was no correlation between gestational age at treatment and survival rate, but there was an inverse association between gestational age at treatment and gestational age at birth. Discussion: In TRAP sequence, survival may be improved by elective intervention at 12-14 weeks.

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Section: Discussionmentioning

confidence: 99%

Optimal Method and Timing of Intrauterine Intervention in Twin Reversed Arterial Perfusion Sequence: Case Study and Meta-Analysis

et al. 2014

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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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“…Unfortunately, the pump twin died as well. Shortly thereafter, Rubèn Quintero from Wayne State University performed the first successful cord ligation (Quintero et al, 1994). In Europe, the Leuven team did the same a few months later, each group working in ignorance of the others' work .…”

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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Umbilical-Cord Ligation of an Acardiac Twin by Fetoscopy at 19 Weeks of Gestation

Cited by 187 publications

References 9 publications

Optimal Method and Timing of Intrauterine Intervention in Twin Reversed Arterial Perfusion Sequence: Case Study and Meta-Analysis

Optimal Method and Timing of Intrauterine Intervention in Twin Reversed Arterial Perfusion Sequence: Case Study and Meta-Analysis

Intrafetal alcohol ablation of an acardiac twin

The making of fetal surgery

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