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Experience with fetoscopic cord ligation
J A Deprest1, P P Van Ballaer, V A Evrard
1Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Leuven, Belgium. Jan.Deprest@uz.kuleuven.ac.be
Objective:
In the case of a monochorionic multiple pregnancy with one non-viable fetus who compromises its co-twin, fetoscopic cord ligation may be performed. We describe our fetoscopic cord ligation technique and discuss the efficacy of cord ligation for salvaging the co-twin, based on available data.
Study Design:
Descriptive case series of four cases and review of the cases published up to 1996.
Results:
We performed four successful ligations. Of the 23 reported cases, which include the present series, two ligations failed. Four fetuses died in utero, and 17 were born alive at a mean of 8 weeks following the procedure. Two babies died in the perinatal period, a third after 60 days. Preterm uterine contractions do not seem to be a clinical problem. Preterm prelabour rupture of the membranes (PPROM) complicates about 40% of cases, the majority occurring prior to 32 weeks.
Conclusion:
Fetoscopic cord ligation is a feasible procedure with a 71% survival rate and a high risk for PPROM.