Fetoscopic cord laser therapy in management of monochorionic monoamniotic twin pregnancies
10.3760/cma.j.cn113903-20210407-00321
- VernacularTitle:单绒毛膜单羊膜囊双胎胎儿镜下激光离断脐带的妊娠结局分析
- Author:
Ying WANG
1
;
Pengbo YUAN
;
Xiaonan XU
;
Xueju WANG
;
Xiaoyue GUO
;
Jing YANG
;
Cheng ZHAO
;
Yuan WEI
;
Yangyu ZHAO
Author Information
1. 北京大学第三医院妇产科 100191
- Keywords:
Pregnancy, twin;
Umbilical cord;
Fetoscopy;
Laser coagulation;
Cord transetion;
Cord entanglement;
Fetal therapies;
Pregnancy outcome
- From:
Chinese Journal of Perinatal Medicine
2021;24(11):806-812
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze fetoscopic cord laser therapy for management of monochorionic monoamniotic (MCMA) twin pregnancies.Methods:The clinical data of fetoscopic cord laser therapy, including cord occlusion, transection, and disentanglement in three pairs of MCMA twins from January 2020 to January 2021 in Peking University Third Hospital were summarized. Literature on cord occlusion and/or transection in MCMA twins were retrieved from Cochrane Library, PubMed, EMBASE, CBM, WanFang, and CNKI from the time at establishment to December 2020. The clinical conditions, surgical indications and methods, disease progression, and maternal and infant prognosis were analyzed.Results:Three cases of MCMA twins in this study period received fetoscopic cord laser therapy between 17-24 weeks, among which two cases gave birth at full-term without any maternal or infant complications, and one was terminated due to fetal malformation. Seven English articles including 29 MCMA twin pregnancies were retrieved. In addition to the three cases reported in this article, a total of 32 cases were analyzed. The indication of cord occlusion and/or transection included twin-reversed arterial perfusion sequence (21.9%, 7/32), fetal malformation (46.9%, 15/32), selective fetal growth restriction (sFGR) (21.9%, 7/32), twin-to-twin transfusion syndrome (TTTS) (3.1%, 1/32), TTTS combined with sFGR (3.1%, 1/32), single intrauterine death (3.1%, 1/32). Gestational age at surgery was between 14 +1 to 27 +3 weeks. No maternal complication due to the operation was reported. After exclusion of two cases who did not receive cord transection and one case was terminated due to fetal malformation, all the other 29 co-twins were born alive at the gestational age between 24 +3 to 40 weeks and birth weight between 800-3 800 g. Among the 29 live born babies, four died soon after birth with unclarified reasons in the literature and one was born with multiple malformations which were detected prenatally, and the other 24 neonates were healthy during the follow-up from 1 month to 9 years old. Conclusions:For MCMA twin pregnant women with umbilical cord entanglement or other indications for fetal reduction, cord occlusion, transection, and disentanglement using fetoscopic cord laser is safe and effective for protecting the surviving fetus.
