title: Fetal surgery in complicated monoamniotic pregnancies: case series and systematic review of the literature.
abstract: OBJECTIVE
  This study aimed to analyze perinatal outcome in monoamniotic (MA) pregnancies that underwent antenatal surgical interventions for fetal complications.
  
  
  METHODS
  Review of all MA pregnancies treated with antenatal surgical interventions in three fetal treatment centers between 2000 and 2013. Indications were twin-twin transfusion syndrome, twin reversed arterial perfusion sequence, discordant anomalies, or elective reduction. We analyzed associations between indication, type of intervention, perinatal survival, and gestational age (GA) at birth and compared our results with a systematic review of the literature.
  
  
  RESULTS
  Fifty-eight MA pregnancies were included. Median GA at treatment was 18.0 weeks (range: 13.1-33.0). Procedures included cord coagulation plus transection (n = 42), cord coagulation without transection (n = 7), laser coagulation of placental anastomoses (n = 7), and one case each with interstitial laser and radiofrequency ablation. Median GA at birth was 34 weeks (range 16.0-41.0), and 75% (53/71) of fetuses intended to survive indeed survived. Literature review included 20 articles, reporting on a total of 45 cases of surgically treated MA pregnancies, showing similar outcome results.
  
  
  CONCLUSIONS
  We present the largest series concerning surgical interventions in complicated MA pregnancies. Despite being rare in experienced hands, a 75% survival is achieved. Collaboration between centers, data sharing, and benchmarking may further improve outcome.
authors.affiliation: Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Suzanne H P
authors.initials: SH
authors.lastname: Peeters
authors.forename: Roland
authors.initials: R
authors.lastname: Devlieger
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Middeldorp
authors.forename: Philip
authors.initials: P
authors.lastname: DeKoninck
authors.forename: Jan
authors.initials: J
authors.lastname: Deprest
authors.forename: Enrico
authors.initials: E
authors.lastname: Lopriore
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Lewi
authors.forename: Frans J
authors.initials: FJ
authors.lastname: Klumper
authors.forename: Eftichia
authors.initials: E
authors.lastname: Kontopoulos
authors.forename: Ruben
authors.initials: R
authors.lastname: Quintero
authors.forename: Dick
authors.initials: D
authors.lastname: Oepkes
mesh_terms: D005260:Female; D005330:Fetofetal Transfusion / Q000453:epidemiology / Q000601:surgery; D005332:Fetoscopy / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000601:surgery*; D059285:Pregnancy, Twin / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014430:Twins, Monozygotic