Selective photocoagulation of communicating vessels in the treatment of monochorionic twins with selective growth retardation.
OBJECTIVE
Current treatment of patients with selective intrauterine growth retardation in monochorionic twins includes expectant management, termination of pregnancy, or umbilical-cord occlusion. The purpose of this study was to assess the outcome of monochorionic twins with selective intrauterine growth retardation who were treated with selective laser photocoagulation of the communicating vessels.


METHODS
Monochorionic twin pregnancies with selective intrauterine growth retardation at less than 26 weeks were eligible for the study. Selective intrauterine growth retardation was defined as <10th percentile for gestational age. Absent or reverse end-diastolic velocity in the umbilical artery of the twin with selective intrauterine growth retardation was required for eligibility after January 2000.


RESULTS
Thirty patients met the criteria for the study: 17 patients were treated expectantly (group I); 2 patients underwent umbilical-cord ligation of the twin with selective intrauterine growth retardation, and 11 patients underwent selective laser photocoagulation of the communicating vessels (group II). Survival rates for at least 1 fetus were no different between groups I and II (14/17 [82.3%] vs 8/11 [72.3%]; P = .4). However, concomitant demise of the co-twin occurred in 4 of 7 patients, and iatrogenic premature delivery for deterioration of the twin with selective intrauterine growth retardation was necessary in 2 patients in group I, which resulted in significant neonatal morbidity. Of the live-born babies, neurologic handicap was present in 3 of 22 babies (13.6%) versus 0 of 12 in groups I and II, respectively (P < .0001).


CONCLUSIONS
Selective intrauterine growth retardation in monochorionic twins can be effectively treated with selective laser photocoagulation of the communicating vessels. By unlinking the circulations between the fetuses, the pregnancy is rendered "functionally" dichorionic, which improves pregnancy treatment and results in decreased neonatal morbidity. This approach constitutes a new valuable alternative in the treatment of monochorionic twin pregnancies with selective intrauterine growth retardation. A randomized clinical trial of expectant treatment versus selective laser photocoagulation of the communicating vessels for monochorionic selective intrauterine growth retardation can be considered.
Quintero
R A
RA
Florida Institute for Fetal Diagnosis and Therapy, St. Joseph's Women's Hospital, Tampa, USA. yvrq@aol.com
Bornick
P W
PW
Morales
W J
WJ
Allen
M H
MH
D001808:Blood Vessels / Q000196:embryology*; D036861:Delivery, Obstetric; D004200:Diseases in Twins; D005260:Female; D005313:Fetal Death; D005317:Fetal Growth Retardation / Q000196:embryology* / Q000601:surgery* / Q000628:therapy; D005330:Fetofetal Transfusion / Q000601:surgery*; D005333:Fetus / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology; D008026:Ligation; D008028:Light Coagulation; D009017:Morbidity; D011247:Pregnancy; D011256:Pregnancy Outcome; D012017:Referral and Consultation; D016019:Survival Analysis; D014430:Twins, Monozygotic; D014470:Umbilical Cord; D014656:Vascular Surgical Procedures