title: Prior uterine bleeding is associated with low visibility due to discolored amniotic fluid on fetoscopic laser photocoagulation.
abstract: OBJECTIVE
  To investigate the association between uterine bleeding preceding fetoscopic laser photocoagulation (FLP) and the presence of discolored amniotic fluid that impedes FLP.
  
  
  METHODS
  A retrospective review of all multiple gestations requiring FLP at the present institution was conducted. The rate of low visibility because of discolored amniotic fluid at the beginning of FLP was compared between patients with and without a history of uterine bleeding, defined as either genital bleeding or ultrasonographically detected subchorionic hematoma.
  
  
  RESULTS
  The prevalence of low visibility because of discolored amniotic fluid was 4.5% (seven in 156 patients). Two of the seven cases of low visibility resulted in double fetal death. The incidence of low visibility was significantly higher in the group with uterine bleeding before surgery compared with that without bleeding (28.6% vs 0.74%, P < 0.001).
  
  
  CONCLUSIONS
  Patients with a history of uterine bleeding prior to FLP may encounter more technical difficulties owing to discolored amniotic fluid during FLP.
authors.affiliation: Department of Obstetrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Yamamoto
authors.affiliation: Department of Obstetrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ishii
authors.affiliation: Department of Obstetrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
authors.forename: Aki
authors.initials: A
authors.lastname: Mabuchi
authors.affiliation: Department of Obstetrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
authors.forename: Shiyo
authors.initials: S
authors.lastname: Oota
authors.affiliation: Department of Obstetrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Haino
authors.affiliation: Department of Obstetrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
authors.forename: Shusaku
authors.initials: S
authors.lastname: Hayashi
authors.affiliation: Department of Obstetrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kanagawa
authors.affiliation: Department of Obstetrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Mitsusda
mesh_terms: D000653:Amniotic Fluid; D016477:Artifacts; D005260:Female; D005313:Fetal Death / Q000209:etiology; D005330:Fetofetal Transfusion / Q000601:surgery; D005332:Fetoscopy / Q000379:methods*; D005865:Gestational Age; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery*; D011272:Pregnancy, Multiple; D012189:Retrospective Studies; D014592:Uterine Hemorrhage / Q000150:complications*
keywords: discolored amniotic fluid; fetoscopic laser photocoagulation; subchorionic hematoma; twin-twin transfusion syndrome; uterine bleeding