Experience of repeated fetoscopic laser coagulation of placental anastomoses in case of recurrence of twin-to-twin transfusion syndrome
https://doi.org/10.18705/2311-4495-2018-5-3-66-69
Abstract
Recurrence of twin-to-twin transfusion syndrome (TTTS) after fetoscopic laser coagulation (FLC) of placental anastomoses is unfavorable complication. Multiparous woman 34 years old in TTTS stage 2 was performed FLC of 8 arteriovenous anastomoses of the placenta followed by amnioreduction of 1000 ml on the gestational age of 22 weeks and 2 days. At gestational age of 24 weeks 6 days was revealed a recurrence of the TTTS, with considerable polyhydramnion of recipient and anhydramnion of the donor, a repeated FLC of 5 residual placental anastomoses was performed and amnioreduction of 2000 ml at 25 weeks 1 day of gestation. On the fifth day was normalized the amount of amniotic fluid of both fetuses. At 32 weeks of gestation spontaneously was began the birth, the weights of newborns were 1560 and 1600 g, both had Apgar score 8/9. Respiratory therapy continued for 7 hours at the second newborn and for 13 hours at the first newborn girl after transferring to the ICU. The signs of the respiratory failure were not observed. There were no differences between complete blood counts. This clinical case confirms the possibility of effective correction of recurrence TTTS with the help of repeated FLC of placental anastomoses.
About the Authors
A. V. Mikhailov
Saint Petersburg State “Maternity Clinic №17”; North-Western State Medical University named after I.I. Mechnikov; Academician I.P. Pavlov First Saint Petersburg State Medical University
Russian Federation
Competing Interests:
Russian Federation
Anton V. Mikhailov - MD, PhD, prof., director and chief of MC №17, chief of department of women’s reproductive health of Mechnikov NW SMU, chief obstetrician-gynecologist of St. Petersburg and NW R RF
Competing Interests:
No conflict of interest
A. N. Romanovsky
Saint Petersburg State “Maternity Clinic №17”; North-Western State Medical University named after I.I. Mechnikov
Russian Federation
Competing Interests:
Russian Federation
Artem N. Romanovsky - MD, maternity department doctor of MC №17, assistant of department of women’s reproductive health of Mechnikov NW SMU
Lesnozavodskaya str. 4/1, Saint Petersburg, 193174
Competing Interests:
No conflict of interest
P. A. Ovsyannikov
Almazov National Medical Research Centre
Russian Federation
Competing Interests:
Russian Federation
Fillip A. Ovsyannikov - PhD, obstetrician-gynecologist.
Saint Petersburg
Competing Interests:
No conflict of interest
T. A. Kashtanova
Saint Petersburg State “Maternity Clinic №17”
Russian Federation
Competing Interests:
Russian Federation
Tatiana A. Kashtanova - MD, chief of department of prenatal diagnostics of MC №17
Competing Interests:
No conflict of interest
I. V. Kyanksep
Saint Petersburg State “Maternity Clinic №17”
Russian Federation
Competing Interests:
Russian Federation
Inna V. Kyanksep - MD, doctor of department of prenatal diagnostics
Competing Interests:
No conflict of interest
А. N. Kyanksep
Saint Petersburg State “Maternity Clinic №17”; Federal state budgetary institution of higher professional education “Saint Petersburg State Pediatric Medical University” of the ministry of healthcare of the Russian Federation
Russian Federation
Competing Interests:
Russian Federation
Alexey N. Kyanksep - MD, subchief of Maternity Clinic №17 in neonatology, assistant of department of neonatology and neonatalogical reanimatology of St. Petersburg state pediatric medical university
Competing Interests:
No conflict of interest
A. A. Kuznetsov
Saint Petersburg State “Maternity Clinic №17”; Academician I.P. Pavlov First Saint Petersburg State Medical University
Russian Federation
Alexander A. Kuznetsov - MD, maternity department doctor of Maternity Clinic №17, PhD student of obstetrics and gynecology department of academician I.P. Pavlov first Saint Petersburg SMU
Competing Interests:
Russian Federation
Alexander A. Kuznetsov - MD, maternity department doctor of Maternity Clinic №17, PhD student of obstetrics and gynecology department of academician I.P. Pavlov first Saint Petersburg SMU
Competing Interests:
No conflict of interest
A. V. Shlykova
Saint Petersburg State “Maternity Clinic №17”; North-Western State Medical University named after I.I. Mechnikov
Russian Federation
Anna V. Shlykova - MD, maternity department doctor of Maternity Hospital №17, PhD student of obstetrics and gynecology department of S.N. Davydov of Mechnikov NW SMU
Competing Interests:
Russian Federation
Anna V. Shlykova - MD, maternity department doctor of Maternity Hospital №17, PhD student of obstetrics and gynecology department of S.N. Davydov of Mechnikov NW SMU
Competing Interests:
No conflict of interest
V. Е. Movchan
Saint Petersburg State “Maternity Clinic №17”; North-Western State Medical University named after I.I. Mechnikov
Russian Federation
Veronika E. Movchan - resident of obstetrics and gynecology department of S.N. Davydov of Mechnikov NW SMU
Competing Interests:
Russian Federation
Veronika E. Movchan - resident of obstetrics and gynecology department of S.N. Davydov of Mechnikov NW SMU
Competing Interests:
No conflict of interest
References
1. Habli M, Bombrys A, Lewis D et al. Incidence of complications in twin-twin transfusion syndrome after selective fetoscopic laser photocoagulation: a single-center experience. Am. J. Obstet. Gynecol. 2009; 201: 417.e1-7.
2. Mikhailov AV, Romanovsky AN, Shlykova AV et al. Specific complications of monochorionic multiple pregnancy — twin-twin transfusion syndrome and anemiapolycythemia syndrome. Obstet Gynecol. 2016; 2: 18-23. In Russian
3. Mikhailov A., Romanovsky A. Multiple pregnancy under ultrasound umbrella. Donald School Journal of Ultrasound in Obstetrics and Gynecology. 2011; 5 (3): 219-230.
4. Mikhailov AV, Romanovsky AN, Kashtanova TA et al. Experience of laser coagulation of vascular placental anastomoses in twin-twin transfusion syndrome. Vestnik Rossiskoi voenno-medicinskoi akademii. 2016; 3 (55): 4750. In Russian
5. Mikhailov AV, Romanovsky AN, Shlykova AV et al. Laser coagulation of vascular placental anastomoses in twintwin transfusion syndrome. Tavricheskiy medico-biologicheskiy vestnik. 2016; 19(2): 167-171. In Russian
6. Ovsyannikov FA, Romanovsky AN. Current treatment of twin-twin transfusion syndrome. Translyatsionnaya meditsina. 2017; 4(4): 36-42. In Russian [Овсянников Ф.А., Романовский А.Н. Современные подходы к лечению фето-фетального трансфузионного синдрома. Трансляционная медицина. 2017; 4 (4): 36-42].
7. Khalek N, Johnson MP, Bebbington MW. Fetoscopic laser therapy for twin-to-twin transfusion syndrome. Seminars in Pediatric Surgery. 2013; 22: 18-23.
8. WAPM consensus group on Twin-to-Twin Transfusion, Baschat A, Chmait RH, Deprest J et al. Twin-to-twin transfusion syndrome (TTTS). J Perinat Med. 2011; 39(2):107 — 112.
9. Quintero RA, Ishii K, Chmait RH et al. Sequential selective laser photocoagulation of communicating vessels in twin-twin transfusion syndrome. J. Matern. Fetal. Neonatal. Med. 2007; 20(10):763-8.
10. Chmait RH, Assaf SA, Benirschke K. Residual vascular communications in twin-twin transfusion syndrome treated with sequential laser surgery: frequency and clinical implications. Placenta. 2010; 31: 611-614.
11. De Lia J, Fisk N, Hecher K et al. Twin-to-twin transfusion syndrome — debates on the etiology, natural history and management. Ultrasound Obstet Gynecol. 2000; 16(3): 210-213.
12. Roberts D. Interventions for twin-twin transfusion syndrome: a Cochrane review. Ultrasound Obstet Gynecol. 2008; 31(6): 701-11.
13. Chmait RH, Korst LM, Llanes A et al. Perioperative characteristics associated with preterm birth in twin-twin transfusion syndrome treated by laser surgery. Am. J. Obstet. Gynecol. 2013; 209: 264.e1-8.
Review
For citations:
Mikhailov A.V., Romanovsky A.N., Ovsyannikov P.A., Kashtanova T.A., Kyanksep I.V., Kyanksep А.N., Kuznetsov A.A., Shlykova A.V., Movchan V.Е. Experience of repeated fetoscopic laser coagulation of placental anastomoses in case of recurrence of twin-to-twin transfusion syndrome. Translational Medicine. 2018;5(3):66-69. (In Russ.) https://doi.org/10.18705/2311-4495-2018-5-3-66-69
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