Perinatal outcome after laser surgery for triplet gestations with feto-fetal transfusion syndrome


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Abstract

ObjectiveThe objective of this study is to evaluate the outcomes of fetoscopic laser photocoagulation (FLP) for a triplet gestation with feto-fetal transfusion syndrome (FFTS).MethodOn the basis of chorionicity, perinatal outcome at 28 days in triplets with FFTS after FLP were evaluated.ResultsFetoscopic laser photocoagulation was completed for all 16 cases including nine dichorionic triamniotic (DT) cases and seven monochorionic triamniotic (MT) cases. The placenta was located anteriorly in six cases. The median gestational age at surgery was 21 (16–25) weeks, and the median operation time was 51 (25–125) minutes. Several technical maneuvers to complete the procedure in MT, such as trocar assistance in two cases, intentional septostomy of the dividing membrane in one, and double uterine entry in one, were used. The median gestational age at delivery was 31 (23–34) weeks. Overall perinatal survival in DT was 74% and that of MT was 95%. All 16 cases resulted in at least one survival, whereas three neonates survived in 44% of DT cases and in 86% of MT cases. Two MT neonates suffered severe intraventricular hemorrhages.ConclusionsFetoscopic laser photocoagulation for FFTS in MT as well as DT triplets seems a valuable treatment. © 2014 John Wiley & Sons, Ltd.What's already known about this topic?The feasibility and efficacy of laser therapy for feto-fetal transfusion syndrome in dichorionic triplets has been recognized; however, because of technical difficulty, its qualities remain undetermined for monochorionic triplets.What does this study add?Laser therapy for feto-fetal transfusion syndrome in both monochorionic and dichorionic triplets might be successful.We describe additional technical maneuvers that can fully evaluate the vascular equator between the triplets.

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