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Related Experiment Videos

Cord occlusion techniques for selective termination in monochorionic twins.

D Challis1, E Gratacos, J A Deprest

  • 1Center for Surgical Technologies, Faculty of Medicine, University of Leuven, Belgium.

Journal of Perinatal Medicine
|January 22, 2000
PubMed
Summary

Selective reduction in complicated monochorionic twin pregnancies requires optimal cord obliteration. Nd:YAG laser before 21 weeks, followed by bipolar cord coagulation, is preferred. Sonoendoscopic ligation is a backup option.

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Area of Science:

  • Maternal-Fetal Medicine
  • Reproductive Medicine
  • Surgical Techniques

Background:

  • Monochorionic (MC) twin pregnancies present unique challenges, including complications requiring selective reduction.
  • Umbilical cord occlusion is a critical intervention in managing these high-risk pregnancies.

Purpose of the Study:

  • To determine the optimal method for umbilical cord obliteration in complicated MC twin pregnancies undergoing selective reduction.
  • To compare the efficacy and safety of various cord obliteration techniques under different clinical conditions.

Main Methods:

  • Systematic review of published literature and unpublished reports on cord embolization, fetoscopic cord ligation, laser coagulation, monopolar coagulation, and bipolar cautery.
  • Analysis of clinical data including indications, procedural success rates, fetal survival, and complications such as preterm prelabor rupture of membranes (PPROM).

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Main Results:

  • Cord embolization has a high failure rate. Fetoscopic cord ligation shows a 10% failure rate and 71% survival but a 30% risk of PPROM.
  • Monopolar coagulation is sparsely reported. Bipolar cord coagulation demonstrated technical success in 10 cases, with 8 fetuses born at ≥35 weeks.
  • Nd:YAG laser coagulation success is gestational age-dependent, with high success rates prior to 20 weeks.

Conclusions:

  • Limited data hinders direct comparison of cord occlusion techniques.
  • A clinical algorithm prioritizes Nd:YAG laser before 21 weeks, followed by bipolar cord coagulation for gestations beyond 21 weeks or laser failure.
  • Sonoendoscopic cord ligation serves as a backup procedure when primary methods are unsuccessful.