Ultrasound-guided umbilical cord occlusion using bipolar diathermy for Stage III/IV twin-twin transfusion syndrome.
OBJECTIVE
To evaluate bipolar diathermy as a technique for selective fetocide in the treatment of advanced (Stage III/IV) twin-twin transfusion syndrome (TTTS).


METHODS
A prospective observational study in two tertiary referral fetal medicine centres: Queen Charlotte's Hospital, London, UK and Haemek Hospital, Afula, Israel. Fifteen cases of TTTS (14 twins and one triplet pregnancy) were treated by selective occlusion of either the donor (n=8) or recipient's (n=7) umbilical cord using ultrasound-guided bipolar diathermy. Following each procedure, patients were scanned serially for fetal growth, liquor volume and umbilical Doppler measurements. Procedural complications and obstetric outcome were recorded. Postnatal placental injection studies were performed.


RESULTS
Overall co-twin survival in Stage III/IV TTTS was 13/14 (93%). There were no treatment failures. The incidence of preterm prelabour rupture of membranes (PPROM) within 3 weeks of the procedure was 3/15 (20%). In those cases where pre-procedure umbilical artery Dopplers were abnormal, the Doppler findings normalised post-procedure in all non-cord-occluded fetuses. Growth velocities of surviving donors were similar to those of surviving recipients.


CONCLUSIONS
Bipolar diathermy appears an effective technique for the selective reduction of monochorionic twins complicated by severe as well as preterminal TTTS, with recipient and donor fetuses being equally appropriate choices for fetocide. We suggest that for advanced-stage disease where the parents can contemplate this option, cord occlusion as a single preemptive procedure maximises the opportunity for intact survival of a single survivor.
Taylor
M J O
MJ
Centre for Fetal Care, Department of Maternal & Fetal Medicine, Imperial College School of Medicine, Queen Charlotte's & Chelsea Hospital, Du Cane Road, London W12 0HS, UK. myles.taylor@ic.ac.uk
Shalev
E
E
Tanawattanacharoen
S
S
Jolly
M
M
Kumar
S
S
Weiner
E
E
Cox
P M
PM
Fisk
N M
NM
D003972:Diathermy / Q000009:adverse effects; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology; D005330:Fetofetal Transfusion / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal; D011446:Prospective Studies; D014463:Ultrasonography; D014470:Umbilical Cord / Q000601:surgery*