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Vol. 22, No. 2, 2007
Issue release date: February 2007
Fetal Diagn Ther 2007;22:149–154

Ultrasound Assessment prior to Laser Photocoagulation for Twin-Twin Transfusion Syndrome for Predicting Intrauterine Fetal Demise after Surgery in Japanese Patients

Ishii K. · Hayashi S. · Nakata M. · Murakoshi T. · Sago H. · Tanaka K.
aDepartment of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, bDivision of Fetal Medicine, National Center for Child Health and Development, Tokyo, cPerinatal Care Center, Yamaguchi University Hospital, Ube, dMaternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, and eJapan Fetoscopy Group, Tokyo, Japan

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Objective: To evaluate the use of ultrasound before selective laser photocoagulation of communicating vessels (SLPCV) for twin–twin transfusion syndrome in predicting intrauterine fetal demise (IUFD). Methods: Fifty-five patients underwent SLPCV in Japan. Fetal biometry and Doppler studies of the umbilical artery, ductus venosus, and umbilical vein were performed prior to SLPCV. The visualization of the bladder and hydrops was recorded. Association between the parameters and IUFD was analyzed using multiple logistic regression analysis. The study was approved by the Institutional Review Board and patients gave their informed consent. Results: The IUFD incidence was 25.5% (14/55) in the donors and 12.7% (7/55) in the recipients. Twelve donors and 4 recipients of them ended in unexplainable IUFD. In the analysis of 53 donors, absent or reversed end-diastolic flow of umbilical artery (UAAREDF) was only associated with IUFD (p = 0.016). No parameters could predict IUFD in 52 recipients. Conclusions: UAAREDF may be useful for predicting IUFD of the donor after SLPCV.

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  1. Mahony BS, Petty CN, Nyberg DA, Luthy DA, Hickok DE, Hirsch JH: The ‘stuck twin’ phenomenon: ultrasonographic findings, pregnancy outcome, and management with serial amniocentesis. Am J Obstet Gynecol 1990;163:1513–1522.
  2. Saunders NJ, Snijders RJ, Nicolaides KH: Therapeutic amniocentesis in twin-twin transfusion syndrome appearing in the second trimester of pregnancy. Am J Obstet Gynecol 1992;166:820–824.
  3. Diehl W, Hecher K, Zikulnig L, Vetter M, Hackeloer B: Placental vascular anastomoses visualized during fetoscopic laser surgery in severe mid-trimester twin-twin transfusion syndrome. Placenta 2001;22:876–881.
  4. Bermudes C, Becerra C, Bornick P, Allen M, Arroyo J, Quintero R: Placental types and twin-twin transfusion syndrome. Am J Obstet Gynecol 2002;187:489–494.
  5. Ville Y, Hecher K, Gagnon A, Sebire N, Hyett J, Nicolaides K: Endoscopic laser coagulation in the management of severe twin-to-twin transfusion syndrome. Br J Obstet Gynaecol 1998;105:446–453.
  6. Hecher K, Plath H, Bregenzer T, Hansmann M, Hackeloer BJ: Endoscopic laser surgery versus serial amniocenteses in the treatment of severe twin-twin transfusion syndrome. Am J Obstet Gynecol 1999;180:717–724.
  7. Quintero RA, Dickenson JE, Morales WJ, Bornick PW, Bermudez C, Cincotta R, Chan FY, Allen MH: Stage-based treatment of twin-twin transfusion syndrome. Am J Obstet Gynecol 2003;188:1333–1340.
  8. Senat MV, Deprest J, Boulvain M, Paupe A, Winer N, Ville Y: Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med 2004;351:136–144.
  9. Zikulnig L, Hecher K, Bregenzer T, Bas E, Hackeloer BJ: Prognostic factors in severe twin-twin transfusion syndrome treated by endoscopic laser surgery. Ultrasound Obstet Gynecol 1999;14:380–387.
  10. Martinez JM, Bermudez C, Becerra C, Lopez J, Morales WJ, Quintero RA: The role of Doppler studies in predicting individual intrauterine fetal demise after laser therapy for twin-twin transfusion syndrome. Ultrasound Obstet Gynecol 2003;22:246–251.
  11. Quintero R, Morales W, Allen M, Bornick P, Johnson P, Kruger M: Staging of twin-twin transfusion syndrome. J Perinatol 1999;19:550–555.
  12. Quintero R, Morales W, Mendoza G, Allen MH, Kalter C, Giannia G, Bornick P, Johnson P, Kruger M: Selective photocoagulation of placental vessels in twin-twin transfusion syndrome: evolution of a surgical technique. Obstet Gynecol Surv 1998;53:s97–s103.
  13. Quintero R, Bornick P, Allen MH, Johnson PK: Selective photocoagulation of placental vessels in severe twin-twin transfusion syndrome in women with an anterior placenta. Obstet Gynecol 2001;97:477–481.
  14. Baldwin VJ: Pathology of Multiple Pregnancy. New York, Springer-Verlag, 1994, pp 215–275.
  15. Gratacos E, Van Schoubroeck D, Carreras E, Devlieger R, Roma E, Carbero L, Deprest J: Impact of laser coagulation in severe twin-twin transfusion syndrome on fetal Doppler indices and venous blood flow volume. Ultrasound Obstet Gynecol 2002;20:125–130.
  16. Ishii K, Chmait RH, Martinez JM, Nakata M, Quitero RA: Ultrasound assessment of venous blood flow before and after laser therapy: approach to understanding the pathophysiology of twin-twin transfusion syndrome. Ultrasound Obstet Gynecol 2004;24:164–168.
  17. Bashat AA: Doppler application in the delivery of the preterm growth-restricted fetus: another step in the right direction. Ultrasound Obstet Gynecol 2004;23:111–118.

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