J Perinat Med. 1999;27(1):61-7.
Treating previable twin-twin transfusion syndrome
with fetoscopic laser surgery: outcomes following the learning
curve.
http://www.ncbi.nlm.nih.gov:80/entrez/query
.fcgi?cmd=
Retrieve&db=PubMed&list_uids=10343935&dopt
=Abstract
De Lia JE, Kuhlmann RS, Lopez KP.
Department of Obstetrics and Gynecology,
University of Illinois at Chicago, USA.
AIMS:
We have performed fetoscopic laser
occlusion of chorioangiopagous vessels (FLOC)
in previable pregnancies affected by twin-twin
transfusion syndrome (TTTS) since 1988. Treatment outcomes
obtained after the procedure's learning
curve are presented and compared to those from
other centers performing FLOC or other treatment
methods.
METHODS:
A total of 100 cases of FLOC
have been performed at our centers. The later 67 TTTS patients
had a mean gestational age of 21.1 +/- 1.7
weeks (range 18-24.5) with a mean fundal height of
33.1 +/- 4.9 cm (range 27-44) when treated.
Eighteen (27%) had failed another treatment
method before FLOC. RESULTS: All 67 cases
have delivered with 82% (55/67) having at least one surviving
twin and 93/134 (69%) of the twins surviving overall. Thirty-eight
have surviving twins, 17 have one survivor (5 neonatal and
12 fetal deaths), and 12
have none. The mean duration of pregnancy
following FLOC was 9.9 +/- 5.5 weeks
(range 1.0-19). Only 4 of 93 (4.3%) survivors
have significant handicaps at a mean follow-up
of 14.3 +/- 10.1 months (range 1.0-34).
CONCLUSION:
Fetoscopic laser occlusion of chorioangiopagous vessels within
the vascular equator limits the duration of fetal pathophysiology
in TTTS and results in neonatal outcomes superior to the modified
procedure and other treatment methods.
PMID: 10343935 [PubMed - indexed for MEDLINE]
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