title: Umbilical Cord Occlusion via Laser Coagulation in Monochorionic Multifetal Gestations before and after 20 Weeks of Gestation.
abstract: BACKGROUND
  Umbilical cord occlusion (UCO) utilizing laser photocoagulation is often not considered an option for selective termination after 20 weeks of gestation due to reported limitations of the procedure because of umbilical cord size. We compared outcomes after laser umbilical cord occlusion (L-UCO) before and after 20 weeks of gestation.
  
  
  METHODS
  We examined all patients with monochorionic- diamniotic twins and higher-order multiples (monoamniotic excluded) that underwent L-UCO at our facility between 2006 and 2014. Statistical analysis was performed using Fisher's exact and Kruskal-Wallis tests as appropriate.
  
  
  RESULTS
  Of 43 L-UCO cases, 11 cases (25.6%) had a discordant anomaly, and 32 cases (74.4%) had twin reversed arterial perfusion (TRAP) sequence. We achieved complete vascular occlusion in 100% (43/43) of cases of attempted L-UCO. There were 22 cases (51.2%) with gestational age ≤20 weeks, and 21 cases (48.8%) with gestational age >20 weeks. Perioperative patient characteristics and outcomes did not differ between the two groups. Survival rates were 90.9% (20/22) and 100% (21/21) at ≤20 weeks of gestation and >20 weeks of gestation, respectively.
  
  
  CONCLUSIONS
  The results of this study suggest that L-UCO is a reasonable surgical modality for patients prior to and beyond 20 weeks of gestation.
authors: Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California, Los Angeles, Calif., USA.
authors: Jennifer R
authors: JR
authors: King
authors: Charlotte L
authors: CL
authors: Conturie
authors: Joseph G
authors: JG
authors: Ouzounian
authors: Lisa M
authors: LM
authors: Korst
authors: Arlyn
authors: A
authors: Llanes
authors: Ramen H
authors: RH
authors: Chmait
mesh_terms: D000328:Adult; D000013:Congenital Abnormalities / Q000000981:diagnostic imaging / Q000196:embryology; D004200:Diseases in Twins / Q000000981:diagnostic imaging / Q000196:embryology; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D017075:Laser Coagulation / Q000009:adverse effects*; D015141:Los Angeles / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal / Q000009:adverse effects*; D011262:Pregnancy Trimester, Second; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D012306:Risk; D016019:Survival Analysis; D060205:Therapeutic Occlusion / Q000009:adverse effects*; D018615:Ultrasonography, Doppler, Color; D016216:Ultrasonography, Prenatal; D014470:Umbilical Cord / Q000601:surgery*
keywords: Monochorionic pregnancy; Selective termination; Umbilical cord occlusion