Fetoscopic laser coagulation for twin-to-twin transfusion syndrome: a comparison of flexible 1.0/1.2â¯mm fetoscopes with curved sheaths of 2.7/3.3â¯mm2 vs. 2â¯mm fetoscopic lens technique with sheaths of 6.6/11.3â¯mm2.
J Perinat Med
; 52(5): 530-537, 2024 Jun 25.
Article
em En
| MEDLINE
| ID: mdl-38536953
ABSTRACT
OBJECTIVES:
Fetoscopic laser coagulation of placental anastomoses is usually performed for a treatment of twin-to-twin transfusion syndrome (TTTS). A common complication of fetoscopic laser coagulation for TTTS is preterm preliminary rupture of fetal membranes (PPROM) aggravating the neonatal outcome significantly. However, use of an flexible 1â¯mm fetoscope with an curved sheath could reduce iatrogenic damage of the amniotic membrane and improve neonatal outcomes after laser treatment. The aim of this study was to compare neonatal outcomes using this flexible fetoscope with curved sheath vs. use of a standard lens technique.METHODS:
Outcomes were retrospective analyzed after use of a standard lens fetoscope of 2â¯mm (sheath 6.63â¯mm2 or 11.27â¯mm2 for anterior placenta) and a flexible fetoscope of 1â¯mm or 1.2â¯mm (sheath 2.65â¯mm2 or 3.34â¯mm2) in two German centers of fetal surgery, performed during 2006-2019.RESULTS:
Neonatal outcome of 247 TTTS patients were analyzed including the rates of double and single fetal survival. The survival of at least one fetus was 97.2â¯% in the group with the ultrathin technique (n=154) compared to 88.3â¯% (n=93) in the group with the standard lens fetoscope (p=0.008). Survival of both fetuses was not different between groups (81.0 vs. 75.3â¯%). The procedure to delivery interval was significantly increased using the ultrathin fetoscope (89.1±35.0â¯d vs. 71.4±35.4â¯d, p=0.001) resulting in an increased gestational age at delivery by 11 days on average (231.9±28.1â¯d vs. 221.1±32.7â¯d, p=0.012).CONCLUSIONS:
Fetal survival can be significantly increased following TTTS using flexible fetoscope of 1â¯mm or 1.2â¯mm (sheath 2.65â¯mm2 or 3.34â¯mm2).Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Fotocoagulação a Laser
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Fetoscópios
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Transfusão Feto-Fetal
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Fetoscopia
Limite:
Adult
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Female
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Humans
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Newborn
/
Pregnancy
Idioma:
En
Revista:
J Perinat Med
/
J. perinat. med
/
Journal of perinatal medicine
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Alemanha
País de publicação:
Alemanha