Complicated monochorionic twin pregnancies: experience with bipolar cord coagulation

Area of Science:

• Maternal-Fetal Medicine
• Perinatology
• Fetal Surgery

Background:

• Monochorionic twin pregnancies face high risks, including twin-to-twin transfusion syndrome and discordant fetal abnormalities.
• Umbilical cord occlusion is a critical intervention for managing these complex conditions.

Purpose of the Study:

• To assess the efficacy and safety of ultrasound-guided bipolar diathermy forceps for umbilical cord occlusion.
• To evaluate the outcomes in complicated monochorionic twin pregnancies undergoing this procedure.

Main Methods:

• Seventeen consecutive cases of complicated monochorionic twins were analyzed.
• Procedures were performed under local anesthesia using 3-mm bipolar diathermy forceps with ultrasound guidance.
• Indications included twin-to-twin transfusion syndrome, twin reversed arterial perfusion syndrome, and discordant fetal abnormalities.

Main Results:

• Successful cord occlusion was achieved in all 17 cases between 18 and 27 weeks' gestation.
• Two co-twin deaths occurred within 12 hours post-procedure (cord hemorrhage, unexplained).
• One neonatal death and one pregnancy termination due to hydrocephaly were noted; other co-twins survived, though some pregnancies experienced preterm delivery.

Conclusions:

• Ultrasound-guided bipolar diathermy is an effective method for umbilical cord occlusion in selected cases.
• The procedure carries significant risks of morbidity and mortality that require careful consideration.