title: Cord occlusion followed by laser cord transection in monochorionic monoamniotic discordant twins.
abstract: OBJECTIVE
  To compare the outcomes of a consecutive case series of monochorionic (MC) monoamniotic (MA) discordant twins treated with umbilical cord occlusion and transection, with those of a cohort of MC diamniotic (DA) twins treated with conventional cord occlusion.
  
  
  METHODS
  This study included 17 MCMA twins (12 true MA and five iatrogenic) treated with cord occlusion and transection and a control group of 72 MCDA discordant twins treated during the same period with cord occlusion in a single center. Duration of surgery, rates of preterm delivery (PTD) or preterm premature rupture of membranes (PPROM) < 32 weeks and intrauterine fetal demise (IUFD), perinatal outcome and neonatal survival were prospectively recorded in both groups.
  
  
  RESULTS
  Median durations of surgery were 28.5 (range, 14.0-74.0) min and 24.0 (3.0-60.0) min in the cord transection and control groups, respectively (P = 0.24). There were no significant differences between cord transection and control groups in the rates of PPROM (35.3% vs. 20.8%, P = 0.22), PTD (41.2% vs. 28.2%, P = 0.29), IUFD (0% vs. 2.8%, P = 1.0) and neonatal survival (76.5% vs. 80.6%, P = 1.0). Gestational age at delivery (median 35.0 (24.5-39.0) vs. 37.1 (26.2-41.0) weeks, P = 0.21) and fetal birth weight (2215 (800-3200) g vs. 2605 (588-3830) g, P = 0.51) were similar between study groups.
  
  
  CONCLUSIONS
  Cord occlusion and transection in MCMA discordant twins resulted in similar perinatal outcomes to those of MCDA discordant twins treated with cord occlusion.
authors.affiliation: Department of Maternal-Fetal Medicine (Institut Clínic de Ginecologia, Obstetrícia i Neonatologia), Hospital Clinic-IDIBAPS, University of Barcelona, and Centro de Investigación Biomédica en Red en Enfermedades Raras, Spain.
authors.forename: D V
authors.initials: DV
authors.lastname: Valsky
authors.forename: M-J
authors.initials: MJ
authors.lastname: Martinez-Serrano
authors.forename: M
authors.initials: M
authors.lastname: Sanz
authors.forename: E
authors.initials: E
authors.lastname: Eixarch
authors.forename: E-R
authors.initials: ER
authors.lastname: Acosta
authors.forename: J-M
authors.initials: JM
authors.lastname: Martinez
authors.forename: B
authors.initials: B
authors.lastname: Puerto
authors.forename: E
authors.initials: E
authors.lastname: Gratacós
mesh_terms: D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D005260:Female; D005315:Fetal Diseases / Q000601:surgery*; D005332:Fetoscopy / Q000379:methods*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D053685:Laser Therapy / Q000379:methods*; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal / Q000379:methods*; D014427:Twins; D014470:Umbilical Cord / Q000002:abnormalities / Q000098:blood supply / Q000601:surgery*; D055815:Young Adult