Embryo reduction in dichorionic triplets to dichorionic twins by intrafetal laser
Petya Chaveeva1, Przemek Kosinski, Cahit Birdir
1Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
Fetal Diagnosis and Therapy
|December 21, 2013
Summary
A new laser ablation technique for embryo reduction (ER) in dichorionic triplet (DCT) pregnancies offers a viable option. This method successfully reduced triplets to dichorionic twins in half of the cases, with good outcomes.
Area of Science:
- Maternal-Fetal Medicine
- Reproductive Sciences
- Medical Technology
Background:
- Dichorionic triplet (DCT) pregnancies pose increased risks.
- Selective embryo reduction (ER) is a management option for high-order multiples.
- Existing ER techniques have limitations.
Purpose of the Study:
- To introduce and evaluate a novel ultrasound-guided intrafetal laser ablation technique for ER in DCT pregnancies.
- To assess the feasibility and outcomes of reducing DCT pregnancies to dichorionic twins.
Main Methods:
- The study involved 22 DCT pregnancies undergoing ER.
- Ultrasound-guided laser ablation of pelvic vessels in one monochorionic twin was performed between 11.3-13.9 weeks' gestation.
- The goal was reduction to dichorionic twins.
Main Results:
- Intrafetal laser ablation was technically successful in all cases.
- The co-twin survived in 11 cases, resulting in dichorionic twins.
- In the dichorionic twin group, 10/11 viable pregnancies resulted in live births at a median of 35.0 weeks.
- In the 11 cases where both monochorionic fetuses died, the remaining triplet was born live at a median of 38.0 weeks.
Conclusions:
- Intrafetal laser ablation is a new, additional option for ER in DCT pregnancies.
- This technique offers an alternative to expectant management or potassium chloride (KCl) injection.
- Further research is needed to compare outcomes with traditional methods.
