Trocar-assisted selective laser photocoagulation of communicating vessels: a technique for the laser treatment of patients with twin-twin transfusion syndrome with inaccessible anterior placentas.

Objective: To describe a new technique, trocar-assisted selective laser photocoagulation of communicating vessels (TA-SLPCV), for patients with twin-twin transfusion syndrome (TTTS) with inaccessible anterior placentas.

Materials And Methods: TA-SLPCV was performed through a single port in TTTS patients with an anterior placenta in whom the anastomoses were inaccessible with a standard technique (inaccessible anterior placentas). The anastomoses were first identified using a 25 or 70-degree rigid diagnostic endoscope.

Triplets with feto-fetal transfusion syndrome treated with laser ablation: the USFetus experience.

Objective: We sought to assess outcomes of triplets with feto-fetal transfusion syndrome (FFTS) treated with selective laser photocoagulation of communicating vessels (SLPCV).

Study Design: All twins and triplets with FFTS treated with SLPCV were analyzed. Triplets were classified as dichorionic-triamniotic (D/T) or monochorionic-triamniotic (M/T).

Dandy-Walker syndrome and monochorionic twins: insight into a possible etiological mechanism.

Objective: Dandy-Walker syndrome (DWS) is a developmental malformation of the central nervous system characterized by complete or partial absence of the cerebellar vermis, the presence of a posterior fossa cyst, and ventriculomegaly. Although DWS can be seen with Mendelian and chromosomal disorders, the actual pathophysiologic mechanism responsible for the syndrome is unknown. The incidence of DWS is approximately 1-8/100,000 births.

Percutaneous fetal sclerotherapy for congenital cystic adenomatoid malformation of the lung.

Objectives: Congenital cystic adenomatoid malformation (CCAM) is a rare lesion of the developing fetal lung consisting of increased cell proliferation in the bronchial structures with lack of differentiation of the alveoli. Pregnancies may be at an increased risk for perinatal loss with type III CCAM. The purpose of this paper is to present our experience with the management of complicated types II and III CCAM with a novel technique: percutaneous ultrasound-guided fetal sclerotherapy (FST).

In utero fetal oximetry via visible light spectroscopy in twin-twin transfusion syndrome.

Objective: The purpose of this study was to assess fetal tissue venous oxygenation (StO2%) in utero during laser therapy for twin-twin transfusion syndrome via visible light spectroscopy (VLS).

Study Design: StO2% was measured in 10 donor and recipient twins at the level of the skin and placenta before and after laser therapy (SLPCV).

Results: Pre-SLPCV skin StO2% was significantly lower in the donor than in the recipient twin (21.

Fetal laryngoscopy and lung biopsy in a case of bilateral lethal congenital cystic adenomatoid malformation of the lung.

A case of prenatal diagnosis of bilateral congenital cystic adenomatoid malformation of the lung (CCAM) is presented. The differential diagnosis among CCAM, pulmonary sequestration, bronchial obstruction, and laryngeal atresia is discussed. The role of diagnostic fetoscopy and fetal lung biopsy as an adjunct to ultrasound is addressed.

General vs local anesthesia for the percutaneous laser treatment of twin-twin transfusion syndrome.

Objective: The purpose of this study was to review our anesthetic experience in selective laser photocoagulation of communicating vessels (SLPCV) to treat twin-twin transfusion syndrome (TTTS).

Study Design: A total of 266 consecutive eligible patients were studied. Twenty-seven patients (10%) underwent general anesthesia (GenA), 100 (38%) received total intravenous anesthesia (TIVA), and 139 (52%) received local anesthesia/conscious sedation (LocA).

Fetal growth after laser therapy for twin-twin transfusion syndrome.

Objective: The objective of the study was to compare twin weight discordance and prevalence of intrauterine growth restriction (IUGR) before laser therapy and after birth in pregnancies complicated by twin-twin transfusion syndrome (TTTS).

Study Design: Women with TTTS who underwent laser therapy with dual neonatal survivors born at least 28 days after surgery were studied. Estimated fetal weight (EFW) discordance at the preoperative sonogram and birthweight (BW) discordance were calculated.

In utero laser treatment of type II vasa previa.

Vasa previa, defined as fetal vessels coursing within the membranes between the presenting part and the cervix, occurs in approximately 1:2500-5000 pregnancies. Type II vasa previa consists of fetal vessels crossing over the internal os connecting a bilobed placenta or a succenturiate lobe with the main placental mass. These vessels are prone to compression during labor or may tear when membranes rupture potentially resulting in fetal exsanguination and neonatal death.

Sequential selective laser photocoagulation of communicating vessels in twin-twin transfusion syndrome.

Objective: We have previously described the selective laser photocoagulation of communicating vessels (SLPCV) technique for the treatment of twin-twin transfusion syndrome (TTTS). Because TTTS is thought to result from a net transfer of blood from the donor twin to the recipient twin, we hypothesized that lasering the arteriovenous anastomoses from the donor to the recipient (AVDRs) first (sequential SLPCV or SQLPCV) would result in an improved hemodynamic status and decreased likelihood of intrauterine fetal demise of the donor twin (IUFD-D).

Materials And Methods: The diagnosis of TTTS was made by ultrasound showing the combined presence of a maximum vertical pocket > or = 8 cm in one sac and < or =2 cm in the other in a monochorionic/diamniotic twin pregnancy.

The role of laser surgery in dissecting the etiology of absent or reverse end-diastolic velocity in the umbilical artery of the donor twin in twin-twin transfusion syndrome.

Objective: This study was undertaken to gain insight on the cause of absent or reverse end-diastolic velocity (AREDV) in the umbilical artery (UA) of the donor twin by analysis of individual placental mass and vascular anastomoses in patients with twin-twin transfusion syndrome (TTTS) treated with laser.

Study Design: TTTS patients who successfully underwent selective laser photocoagulation of communicating vessels (SLPCV), 16 and 26 weeks' gestation, with both twins born alive and complete Doppler and placental data were considered eligible for the study. Doppler examination of the UA was performed before and 24 hours after SLPCV.

Surgical management of twin reversed arterial perfusion sequence.

Objective: The purpose of this study was to review our experience in the management of twin reversed arterial perfusion sequence to derive management recommendations.

Study Design: All patients with twin reversed arterial perfusion sequence who were seen for consultation between 1993 and 2004 were studied. Criteria for umbilical cord occlusion included abdominal circumference of the twin reversed arterial perfusion fetus that was more than or equal to the pump twin, polyhydramnios (maximum vertical pocket > or = 8 cm), abnormal Doppler studies or hydrops of the pump twin, or monoamniotic twins.

Stage-based treatment of twin-twin transfusion syndrome.

Objective: The purpose of this study was to compare the outcomes of patients with twin-twin transfusion syndrome who were treated with either serial amniocentesis or selective laser photocoagulation of communicating vessels according to disease severity (stage).

Study Design: Centers that were experienced in the treatment of twin-twin transfusion syndrome were invited to share stage-based perinatal outcome data. All patients met basic standard sonographic criteria for twin-twin transfusion syndrome (polyhydramnios maximum vertical pocket, > or =8 cm; oligohydramnios maximum vertical pocket, < or =2 cm).

Placental types and twin-twin transfusion syndrome.

Objective: The purpose of this study was to assess the value of a proposed classification of monochorionic placenta in reference to twin-twin transfusion syndrome.

Study Design: The placentas from laser-treated patients with twin-twin transfusion syndrome and from uncomplicated monochorionic pregnancies that were delivered between January 1997 and December 2000 were included in the study. Placentas were classified as type A (no anastomoses), type B (only deep anastomoses), type C (only superficial anastomoses), and type D (deep and superficial anastomoses).

Surgical treatment of spontaneous rupture of membranes: the amniograft--first experience.

A 28-year-old woman underwent surgical repair of spontaneous ruptured membranes at 17 weeks' gestation. A collagen graft was placed endoscopically over the membrane defect located over the internal os. Membranes re-ruptured 14 days later, but the patient did not deliver until 30.