title: Feasibility and preliminary outcomes of fetoscopic laser photocoagulation for monochorionic twin gestation with selective intrauterine growth restriction accompanied by severe oligohydramnios.
abstract: OBJECTIVE
  This study aimed to clarify the feasibility and perinatal outcomes of fetoscopic laser photocoagulation (FLP) for monochorionic twin gestation with selective intrauterine growth restriction (sIUGR) accompanied by both abnormal umbilical artery Doppler waveforms and isolated severe oligohydramnios of the sIUGR twin.
  
  
  METHODS
  In this prospective clinical trial, which included 10 cases with absent or reversed end-diastolic flow in the umbilical artery and severe oligohydramnios of the sIUGR twin, the main outcomes investigated were the feasibility of FLP and the rate of severe FLP-related maternal complications. The survival rate and incidence of neurological abnormalities of the twins at 28 days of age were also evaluated.
  
  
  RESULTS
  FLP was completed for all cases without major intraoperative maternal complications, although one case experienced threatened preterm labor requiring intensive treatment after the procedure. Three sIUGR and 10 larger twins were alive without neurological abnormalities at 28 days of age, while intrauterine fetal death occurred in the remaining seven sIUGR twins.
  
  
  CONCLUSIONS
  FLP for monochorionic twins with sIUGR, especially when accompanied by abnormal Doppler and severe oligohydramnios of the sIUGR twin, appears to be feasible and potentially beneficial for the larger twin, as well as for some sIUGR twins.
authors.affiliation: Department of Maternal Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ishii
authors.affiliation: Department of Obstetrics and Gynecology, Tokuyama Central Hospital, Shunan, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Nakata
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Wada
authors.affiliation: Department of Perinatology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Murakoshi
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Sago
mesh_terms: D005240:Feasibility Studies; D005260:Female; D005313:Fetal Death; D005317:Fetal Growth Retardation / Q000401:mortality / Q000601:surgery*; D005332:Fetoscopy / Q000379:methods*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D017075:Laser Coagulation / Q000379:methods*; D016104:Oligohydramnios / Q000401:mortality / Q000601:surgery*; D011247:Pregnancy; D059285:Pregnancy, Twin; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014430:Twins, Monozygotic; D016216:Ultrasonography, Prenatal
keywords: fetal therapy; laser therapy; monochorionic twin; multiple gestation; oligohydramnios; selective intrauterine growth restriction