Experience with fetoscopic cord ligation
Identifieur interne : 001393 ( Istex/Corpus ); précédent : 001392; suivant : 001394Experience with fetoscopic cord ligation
Auteurs : Jan A. Deprest ; Paul P. Van Ballaer ; Veerle A. Evrard ; Koen H. E Peers ; Bernard Spitz ; Erik A. Steegers ; Kamiel VandenbergheSource :
- European Journal of Obstetrics and Gynecology [ 0301-2115 ] ; 1998.
Abstract
Objective. In the case of a monochorionic multiple pregnancy with one non-viable fetus who compromises its co-twin, fetoscopic cord ligation may be performed. We describe our fetoscopic cord ligation technique and discuss the efficacy of cord ligation for salvaging the co-twin, based on available data. Study design. Descriptive case series of four cases and review of the cases published up to 1996. Results. We performed four successful ligations. Of the 23 reported cases, which include the present series, two ligations failed. Four fetuses died in utero, and 17 were born alive at a mean of 8 weeks following the procedure. Two babies died in the perinatal period, a third after 60 days. Preterm uterine contractions do not seem to be a clinical problem. Preterm prelabour rupture of the membranes (PPROM) complicates about 40% of cases, the majority occurring prior to 32 weeks. Conclusion. Fetoscopic cord ligation is a feasible procedure with a 71% survival rate and a high risk for PPROM.
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DOI: 10.1016/S0301-2115(98)00181-X
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title>Experience with fetoscopic cord ligation</title><author><name sortKey="Deprest, Jan A" sort="Deprest, Jan A" uniqKey="Deprest J" first="Jan A" last="Deprest">Jan A. Deprest</name><affiliation><mods:affiliation>Department of Obstetrics and Gynaecology, University Hospital `Gasthuisberg', Leuven, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Van Ballaer, Paul P" sort="Van Ballaer, Paul P" uniqKey="Van Ballaer P" first="Paul P" last="Van Ballaer">Paul P. Van Ballaer</name><affiliation><mods:affiliation>Centre for Surgical Technologies, Faculty of Medicine, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Evrard, Veerle A" sort="Evrard, Veerle A" uniqKey="Evrard V" first="Veerle A" last="Evrard">Veerle A. Evrard</name><affiliation><mods:affiliation>Centre for Surgical Technologies, Faculty of Medicine, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Peers, Koen H E" sort="Peers, Koen H E" uniqKey="Peers K" first="Koen H. E" last="Peers">Koen H. E Peers</name><affiliation><mods:affiliation>Centre for Surgical Technologies, Faculty of Medicine, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Spitz, Bernard" sort="Spitz, Bernard" uniqKey="Spitz B" first="Bernard" last="Spitz">Bernard Spitz</name><affiliation><mods:affiliation>Department of Obstetrics and Gynaecology, University Hospital `Gasthuisberg', Leuven, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Steegers, Erik A" sort="Steegers, Erik A" uniqKey="Steegers E" first="Erik A" last="Steegers">Erik A. Steegers</name><affiliation><mods:affiliation>Department of Obstetrics and Gynaecology, Sint-Radboudziekenhuis, Nijmegen, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Vandenberghe, Kamiel" sort="Vandenberghe, Kamiel" uniqKey="Vandenberghe K" first="Kamiel" last="Vandenberghe">Kamiel Vandenberghe</name><affiliation><mods:affiliation>Department of Obstetrics and Gynaecology, University Hospital `Gasthuisberg', Leuven, Belgium</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:48486F5A107FF8A142E3AD62DDE149C48AAC67BB</idno><date when="1998" year="1998">1998</date><idno type="doi">10.1016/S0301-2115(98)00181-X</idno><idno type="url">https://api.istex.fr/document/48486F5A107FF8A142E3AD62DDE149C48AAC67BB/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">001393</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Experience with fetoscopic cord ligation</title><author><name sortKey="Deprest, Jan A" sort="Deprest, Jan A" uniqKey="Deprest J" first="Jan A" last="Deprest">Jan A. Deprest</name><affiliation><mods:affiliation>Department of Obstetrics and Gynaecology, University Hospital `Gasthuisberg', Leuven, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Van Ballaer, Paul P" sort="Van Ballaer, Paul P" uniqKey="Van Ballaer P" first="Paul P" last="Van Ballaer">Paul P. Van Ballaer</name><affiliation><mods:affiliation>Centre for Surgical Technologies, Faculty of Medicine, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Evrard, Veerle A" sort="Evrard, Veerle A" uniqKey="Evrard V" first="Veerle A" last="Evrard">Veerle A. Evrard</name><affiliation><mods:affiliation>Centre for Surgical Technologies, Faculty of Medicine, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Peers, Koen H E" sort="Peers, Koen H E" uniqKey="Peers K" first="Koen H. E" last="Peers">Koen H. E Peers</name><affiliation><mods:affiliation>Centre for Surgical Technologies, Faculty of Medicine, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Spitz, Bernard" sort="Spitz, Bernard" uniqKey="Spitz B" first="Bernard" last="Spitz">Bernard Spitz</name><affiliation><mods:affiliation>Department of Obstetrics and Gynaecology, University Hospital `Gasthuisberg', Leuven, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Steegers, Erik A" sort="Steegers, Erik A" uniqKey="Steegers E" first="Erik A" last="Steegers">Erik A. Steegers</name><affiliation><mods:affiliation>Department of Obstetrics and Gynaecology, Sint-Radboudziekenhuis, Nijmegen, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Vandenberghe, Kamiel" sort="Vandenberghe, Kamiel" uniqKey="Vandenberghe K" first="Kamiel" last="Vandenberghe">Kamiel Vandenberghe</name><affiliation><mods:affiliation>Department of Obstetrics and Gynaecology, University Hospital `Gasthuisberg', Leuven, Belgium</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">European Journal of Obstetrics and Gynecology</title><title level="j" type="abbrev">EURO</title><idno type="ISSN">0301-2115</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1998">1998</date><biblScope unit="volume">81</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="157">157</biblScope><biblScope unit="page" to="164">164</biblScope></imprint><idno type="ISSN">0301-2115</idno></series><idno type="istex">48486F5A107FF8A142E3AD62DDE149C48AAC67BB</idno><idno type="DOI">10.1016/S0301-2115(98)00181-X</idno><idno type="PII">S0301-2115(98)00181-X</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0301-2115</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objective. In the case of a monochorionic multiple pregnancy with one non-viable fetus who compromises its co-twin, fetoscopic cord ligation may be performed. We describe our fetoscopic cord ligation technique and discuss the efficacy of cord ligation for salvaging the co-twin, based on available data. Study design. Descriptive case series of four cases and review of the cases published up to 1996. Results. We performed four successful ligations. Of the 23 reported cases, which include the present series, two ligations failed. Four fetuses died in utero, and 17 were born alive at a mean of 8 weeks following the procedure. Two babies died in the perinatal period, a third after 60 days. Preterm uterine contractions do not seem to be a clinical problem. Preterm prelabour rupture of the membranes (PPROM) complicates about 40% of cases, the majority occurring prior to 32 weeks. Conclusion. Fetoscopic cord ligation is a feasible procedure with a 71% survival rate and a high risk for PPROM.</div></front></TEI><istex><corpusName>elsevier</corpusName><author><json:item><name>Jan A Deprest</name><affiliations><json:string>Department of Obstetrics and Gynaecology, University Hospital `Gasthuisberg', Leuven, Belgium</json:string></affiliations></json:item><json:item><name>Paul P Van Ballaer</name><affiliations><json:string>Centre for Surgical Technologies, Faculty of Medicine, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium</json:string></affiliations></json:item><json:item><name>Veerle A Evrard</name><affiliations><json:string>Centre for Surgical Technologies, Faculty of Medicine, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium</json:string></affiliations></json:item><json:item><name>Koen H.E Peers</name><affiliations><json:string>Centre for Surgical Technologies, Faculty of Medicine, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium</json:string></affiliations></json:item><json:item><name>Bernard Spitz</name><affiliations><json:string>Department of Obstetrics and Gynaecology, University Hospital `Gasthuisberg', Leuven, Belgium</json:string></affiliations></json:item><json:item><name>Erik A Steegers</name><affiliations><json:string>Department of Obstetrics and Gynaecology, Sint-Radboudziekenhuis, Nijmegen, The Netherlands</json:string></affiliations></json:item><json:item><name>Kamiel Vandenberghe</name><affiliations><json:string>Department of Obstetrics and Gynaecology, University Hospital `Gasthuisberg', Leuven, Belgium</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Acardiac</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Cord ligation</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Feticide</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Feto-fetal transfusion syndrome</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Fetoscopy</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Monochorionic twins</value></json:item></subject><language><json:string>eng</json:string></language><originalGenre><json:string>Full-length article</json:string></originalGenre><abstract>Objective. In the case of a monochorionic multiple pregnancy with one non-viable fetus who compromises its co-twin, fetoscopic cord ligation may be performed. We describe our fetoscopic cord ligation technique and discuss the efficacy of cord ligation for salvaging the co-twin, based on available data. Study design. Descriptive case series of four cases and review of the cases published up to 1996. Results. We performed four successful ligations. Of the 23 reported cases, which include the present series, two ligations failed. Four fetuses died in utero, and 17 were born alive at a mean of 8 weeks following the procedure. Two babies died in the perinatal period, a third after 60 days. Preterm uterine contractions do not seem to be a clinical problem. Preterm prelabour rupture of the membranes (PPROM) complicates about 40% of cases, the majority occurring prior to 32 weeks. Conclusion. Fetoscopic cord ligation is a feasible procedure with a 71% survival rate and a high risk for PPROM.</abstract><qualityIndicators><score>6.728</score><pdfVersion>1.2</pdfVersion><pdfPageSize>598 x 793 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>6</keywordCount><abstractCharCount>998</abstractCharCount><pdfWordCount>4796</pdfWordCount><pdfCharCount>30627</pdfCharCount><pdfPageCount>8</pdfPageCount><abstractWordCount>161</abstractWordCount></qualityIndicators><title>Experience with fetoscopic cord ligation</title><pii><json:string>S0301-2115(98)00181-X</json:string></pii><genre><json:string>research-article</json:string></genre><host><volume>81</volume><pii><json:string>S0301-2115(00)X0042-5</json:string></pii><pages><last>164</last><first>157</first></pages><issn><json:string>0301-2115</json:string></issn><issue>2</issue><genre><json:string>journal</json:string></genre><language><json:string>unknown</json:string></language><title>European Journal of Obstetrics and Gynecology</title><publicationDate>1998</publicationDate></host><categories><wos><json:string>OBSTETRICS & GYNECOLOGY</json:string><json:string>REPRODUCTIVE BIOLOGY</json:string></wos></categories><publicationDate>1998</publicationDate><copyrightDate>1998</copyrightDate><doi><json:string>10.1016/S0301-2115(98)00181-X</json:string></doi><id>48486F5A107FF8A142E3AD62DDE149C48AAC67BB</id><score>0.22910616</score><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/48486F5A107FF8A142E3AD62DDE149C48AAC67BB/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/48486F5A107FF8A142E3AD62DDE149C48AAC67BB/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/48486F5A107FF8A142E3AD62DDE149C48AAC67BB/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a">Experience with fetoscopic cord ligation</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>©1998 Elsevier Science Ireland Ltd</p></availability><date>1998</date></publicationStmt><notesStmt><note type="content">Fig. 1: Organisation of the operation room for operative fetoscopy. In this case cord ligation of the left-sided twin is performed with a target area above the cervix. Ultrasound operator (1) and equipment (US) are on the left side, while the surgeon and his assisting nurse (2, 3) are on the right side. Videomonitor and endoscopic hardware (TV) are at the feet of the patient. The anaesthesiologist (4) is at the head of the patient.</note><note type="content">Fig. 2: Cannula and dilator with valve system and irrigation connection, amniocentesis needle (18 G) and guide wire.</note><note type="content">Fig. 3: Technique of two port fetoscopic cord ligation. The amniotic sac of the acardiac, lying under the placenta, has been incised. Instruments are inserted into that sac to perform the actual procedure. Ports were attached to the fascia with a retention disc. Amnioinfusion enters by the scope, and drainage is through the ports. (Reprinted, with permission, from Prenatal Diagnosis, Wiley, Chichester [33](modified).)</note><note type="content">Fig. 4: Fetoscopic cord ligation. (A) Insertion of suture, the suture being held with 2.67 mm rigid forceps; (B) rigid forceps hands suture to second forceps introduced through the operative channel of the fetoscope; (C) conventional extra-corporeal knot tying is performed. The fetoscope is inserted through the loop to avoid direct tension on the cord while knotting. Ultrasound back up is necessary.</note><note type="content">Table 1: Summary of published individual cases</note><note type="content">Table 2: Summary of published results</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Experience with fetoscopic cord ligation</title><author xml:id="author-1"><persName><forename type="first">Jan A</forename><surname>Deprest</surname></persName><note type="correspondence"><p>Corresponding author. Correspondence address: Department of Obstetrics and Gynaecology, UZ Leuven, B-3000 Leuven, Belgium. Tel.: +32-16-344215; fax: +32-16-344205; e-mail: Jan.Deprest@uz.kuleuven.ac.be</p></note><affiliation>Department of Obstetrics and Gynaecology, University Hospital `Gasthuisberg', Leuven, Belgium</affiliation></author><author xml:id="author-2"><persName><forename type="first">Paul P</forename><surname>Van Ballaer</surname></persName><affiliation>Centre for Surgical Technologies, Faculty of Medicine, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium</affiliation></author><author xml:id="author-3"><persName><forename type="first">Veerle A</forename><surname>Evrard</surname></persName><affiliation>Centre for Surgical Technologies, Faculty of Medicine, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium</affiliation></author><author xml:id="author-4"><persName><forename type="first">Koen H.E</forename><surname>Peers</surname></persName><affiliation>Centre for Surgical Technologies, Faculty of Medicine, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium</affiliation></author><author xml:id="author-5"><persName><forename type="first">Bernard</forename><surname>Spitz</surname></persName><affiliation>Department of Obstetrics and Gynaecology, University Hospital `Gasthuisberg', Leuven, Belgium</affiliation></author><author xml:id="author-6"><persName><forename type="first">Erik A</forename><surname>Steegers</surname></persName><affiliation>Department of Obstetrics and Gynaecology, Sint-Radboudziekenhuis, Nijmegen, The Netherlands</affiliation></author><author xml:id="author-7"><persName><forename type="first">Kamiel</forename><surname>Vandenberghe</surname></persName><affiliation>Department of Obstetrics and Gynaecology, University Hospital `Gasthuisberg', Leuven, Belgium</affiliation></author></analytic><monogr><title level="j">European Journal of Obstetrics and Gynecology</title><title level="j" type="abbrev">EURO</title><idno type="pISSN">0301-2115</idno><idno type="PII">S0301-2115(00)X0042-5</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1998"></date><biblScope unit="volume">81</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="157">157</biblScope><biblScope unit="page" to="164">164</biblScope></imprint></monogr><idno type="istex">48486F5A107FF8A142E3AD62DDE149C48AAC67BB</idno><idno type="DOI">10.1016/S0301-2115(98)00181-X</idno><idno type="PII">S0301-2115(98)00181-X</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1998</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Objective. In the case of a monochorionic multiple pregnancy with one non-viable fetus who compromises its co-twin, fetoscopic cord ligation may be performed. We describe our fetoscopic cord ligation technique and discuss the efficacy of cord ligation for salvaging the co-twin, based on available data. Study design. Descriptive case series of four cases and review of the cases published up to 1996. Results. We performed four successful ligations. Of the 23 reported cases, which include the present series, two ligations failed. Four fetuses died in utero, and 17 were born alive at a mean of 8 weeks following the procedure. Two babies died in the perinatal period, a third after 60 days. Preterm uterine contractions do not seem to be a clinical problem. Preterm prelabour rupture of the membranes (PPROM) complicates about 40% of cases, the majority occurring prior to 32 weeks. Conclusion. Fetoscopic cord ligation is a feasible procedure with a 71% survival rate and a high risk for PPROM.</p></abstract><textClass><keywords scheme="keyword"><list><head>Keywords</head><item><term>Acardiac</term></item><item><term>Cord ligation</term></item><item><term>Feticide</term></item><item><term>Feto-fetal transfusion syndrome</term></item><item><term>Fetoscopy</term></item><item><term>Monochorionic twins</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="1998">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/48486F5A107FF8A142E3AD62DDE149C48AAC67BB/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier, elements deleted: ce:floats; body; tail"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 4.5.2//EN//XML" URI="art452.dtd" name="istex:docType"><istex:entity SYSTEM="gr1" NDATA="IMAGE" name="gr1"></istex:entity><istex:entity SYSTEM="gr2" NDATA="IMAGE" name="gr2"></istex:entity><istex:entity SYSTEM="gr3" NDATA="IMAGE" name="gr3"></istex:entity><istex:entity SYSTEM="gr4" NDATA="IMAGE" name="gr4"></istex:entity></istex:docType><istex:document><converted-article version="4.5.2" docsubtype="fla"><item-info><jid>EURO</jid><aid>3139</aid><ce:pii>S0301-2115(98)00181-X</ce:pii><ce:doi>10.1016/S0301-2115(98)00181-X</ce:doi><ce:copyright year="1998" type="full-transfer">Elsevier Science Ireland Ltd</ce:copyright></item-info><head><ce:title>Experience with fetoscopic cord ligation</ce:title><ce:author-group><ce:author><ce:given-name>Jan A</ce:given-name><ce:surname>Deprest</ce:surname><ce:cross-ref refid="AFF1">a</ce:cross-ref><ce:cross-ref refid="AFF2">b</ce:cross-ref><ce:cross-ref refid="CORR1">*</ce:cross-ref></ce:author><ce:author><ce:given-name>Paul P</ce:given-name><ce:surname>Van Ballaer</ce:surname><ce:cross-ref refid="AFF2">b</ce:cross-ref></ce:author><ce:author><ce:given-name>Veerle A</ce:given-name><ce:surname>Evrard</ce:surname><ce:cross-ref refid="AFF2">b</ce:cross-ref></ce:author><ce:author><ce:given-name>Koen H.E</ce:given-name><ce:surname>Peers</ce:surname><ce:cross-ref refid="AFF2">b</ce:cross-ref></ce:author><ce:author><ce:given-name>Bernard</ce:given-name><ce:surname>Spitz</ce:surname><ce:cross-ref refid="AFF1">a</ce:cross-ref></ce:author><ce:author><ce:given-name>Erik A</ce:given-name><ce:surname>Steegers</ce:surname><ce:cross-ref refid="AFF3">c</ce:cross-ref></ce:author><ce:author><ce:given-name>Kamiel</ce:given-name><ce:surname>Vandenberghe</ce:surname><ce:cross-ref refid="AFF1">a</ce:cross-ref></ce:author><ce:affiliation id="AFF1"><ce:label>a</ce:label><ce:textfn>Department of Obstetrics and Gynaecology, University Hospital `Gasthuisberg', Leuven, Belgium</ce:textfn></ce:affiliation><ce:affiliation id="AFF2"><ce:label>b</ce:label><ce:textfn>Centre for Surgical Technologies, Faculty of Medicine, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium</ce:textfn></ce:affiliation><ce:affiliation id="AFF3"><ce:label>c</ce:label><ce:textfn>Department of Obstetrics and Gynaecology, Sint-Radboudziekenhuis, Nijmegen, The Netherlands</ce:textfn></ce:affiliation><ce:correspondence id="CORR1"><ce:label>*</ce:label><ce:text>Corresponding author. Correspondence address: Department of Obstetrics and Gynaecology, UZ Leuven, B-3000 Leuven, Belgium. Tel.: +32-16-344215; fax: +32-16-344205; e-mail: Jan.Deprest@uz.kuleuven.ac.be</ce:text></ce:correspondence></ce:author-group><ce:abstract><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para><ce:italic>Objective</ce:italic>. In the case of a monochorionic multiple pregnancy with one non-viable fetus who compromises its co-twin, fetoscopic cord ligation may be performed. We describe our fetoscopic cord ligation technique and discuss the efficacy of cord ligation for salvaging the co-twin, based on available data.</ce:simple-para><ce:simple-para><ce:italic>Study design</ce:italic>. Descriptive case series of four cases and review of the cases published up to 1996.</ce:simple-para><ce:simple-para><ce:italic>Results</ce:italic>. We performed four successful ligations. Of the 23 reported cases, which include the present series, two ligations failed. Four fetuses died in utero, and 17 were born alive at a mean of 8 weeks following the procedure. Two babies died in the perinatal period, a third after 60 days. Preterm uterine contractions do not seem to be a clinical problem. Preterm prelabour rupture of the membranes (PPROM) complicates about 40% of cases, the majority occurring prior to 32 weeks.</ce:simple-para><ce:simple-para><ce:italic>Conclusion</ce:italic>. Fetoscopic cord ligation is a feasible procedure with a 71% survival rate and a high risk for PPROM.</ce:simple-para></ce:abstract-sec></ce:abstract><ce:keywords class="keyword"><ce:section-title>Keywords</ce:section-title><ce:keyword><ce:text>Acardiac</ce:text></ce:keyword><ce:keyword><ce:text>Cord ligation</ce:text></ce:keyword><ce:keyword><ce:text>Feticide</ce:text></ce:keyword><ce:keyword><ce:text>Feto-fetal transfusion syndrome</ce:text></ce:keyword><ce:keyword><ce:text>Fetoscopy</ce:text></ce:keyword><ce:keyword><ce:text>Monochorionic twins</ce:text></ce:keyword></ce:keywords></head></converted-article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Experience with fetoscopic cord ligation</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Experience with fetoscopic cord ligation</title></titleInfo><name type="personal"><namePart type="given">Jan A</namePart><namePart type="family">Deprest</namePart><affiliation>Department of Obstetrics and Gynaecology, University Hospital `Gasthuisberg', Leuven, Belgium</affiliation><description>Corresponding author. Correspondence address: Department of Obstetrics and Gynaecology, UZ Leuven, B-3000 Leuven, Belgium. Tel.: +32-16-344215; fax: +32-16-344205; e-mail: Jan.Deprest@uz.kuleuven.ac.be</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Paul P</namePart><namePart type="family">Van Ballaer</namePart><affiliation>Centre for Surgical Technologies, Faculty of Medicine, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Veerle A</namePart><namePart type="family">Evrard</namePart><affiliation>Centre for Surgical Technologies, Faculty of Medicine, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Koen H.E</namePart><namePart type="family">Peers</namePart><affiliation>Centre for Surgical Technologies, Faculty of Medicine, Katholieke Universiteit Leuven, B-3000 Leuven, Belgium</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Bernard</namePart><namePart type="family">Spitz</namePart><affiliation>Department of Obstetrics and Gynaecology, University Hospital `Gasthuisberg', Leuven, Belgium</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Erik A</namePart><namePart type="family">Steegers</namePart><affiliation>Department of Obstetrics and Gynaecology, Sint-Radboudziekenhuis, Nijmegen, The Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Kamiel</namePart><namePart type="family">Vandenberghe</namePart><affiliation>Department of Obstetrics and Gynaecology, University Hospital `Gasthuisberg', Leuven, Belgium</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1998</dateIssued><copyrightDate encoding="w3cdtf">1998</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">Objective. In the case of a monochorionic multiple pregnancy with one non-viable fetus who compromises its co-twin, fetoscopic cord ligation may be performed. We describe our fetoscopic cord ligation technique and discuss the efficacy of cord ligation for salvaging the co-twin, based on available data. Study design. Descriptive case series of four cases and review of the cases published up to 1996. Results. We performed four successful ligations. Of the 23 reported cases, which include the present series, two ligations failed. Four fetuses died in utero, and 17 were born alive at a mean of 8 weeks following the procedure. Two babies died in the perinatal period, a third after 60 days. Preterm uterine contractions do not seem to be a clinical problem. Preterm prelabour rupture of the membranes (PPROM) complicates about 40% of cases, the majority occurring prior to 32 weeks. Conclusion. Fetoscopic cord ligation is a feasible procedure with a 71% survival rate and a high risk for PPROM.</abstract><note type="content">Fig. 1: Organisation of the operation room for operative fetoscopy. In this case cord ligation of the left-sided twin is performed with a target area above the cervix. Ultrasound operator (1) and equipment (US) are on the left side, while the surgeon and his assisting nurse (2, 3) are on the right side. Videomonitor and endoscopic hardware (TV) are at the feet of the patient. The anaesthesiologist (4) is at the head of the patient.</note><note type="content">Fig. 2: Cannula and dilator with valve system and irrigation connection, amniocentesis needle (18 G) and guide wire.</note><note type="content">Fig. 3: Technique of two port fetoscopic cord ligation. The amniotic sac of the acardiac, lying under the placenta, has been incised. Instruments are inserted into that sac to perform the actual procedure. Ports were attached to the fascia with a retention disc. Amnioinfusion enters by the scope, and drainage is through the ports. (Reprinted, with permission, from Prenatal Diagnosis, Wiley, Chichester [33](modified).)</note><note type="content">Fig. 4: Fetoscopic cord ligation. (A) Insertion of suture, the suture being held with 2.67 mm rigid forceps; (B) rigid forceps hands suture to second forceps introduced through the operative channel of the fetoscope; (C) conventional extra-corporeal knot tying is performed. The fetoscope is inserted through the loop to avoid direct tension on the cord while knotting. Ultrasound back up is necessary.</note><note type="content">Table 1: Summary of published individual cases</note><note type="content">Table 2: Summary of published results</note><subject><genre>Keywords</genre><topic>Acardiac</topic><topic>Cord ligation</topic><topic>Feticide</topic><topic>Feto-fetal transfusion syndrome</topic><topic>Fetoscopy</topic><topic>Monochorionic twins</topic></subject><relatedItem type="host"><titleInfo><title>European Journal of Obstetrics and Gynecology</title></titleInfo><titleInfo type="abbreviated"><title>EURO</title></titleInfo><genre type="journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">19981201</dateIssued></originInfo><identifier type="ISSN">0301-2115</identifier><identifier type="PII">S0301-2115(00)X0042-5</identifier><part><date>19981201</date><detail type="volume"><number>81</number><caption>vol.</caption></detail><detail type="issue"><number>2</number><caption>no.</caption></detail><extent unit="issue pages"><start>133</start><end>304</end></extent><extent unit="pages"><start>157</start><end>164</end></extent></part></relatedItem><identifier type="istex">48486F5A107FF8A142E3AD62DDE149C48AAC67BB</identifier><identifier type="DOI">10.1016/S0301-2115(98)00181-X</identifier><identifier type="PII">S0301-2115(98)00181-X</identifier><accessCondition type="use and reproduction" contentType="copyright">©1998 Elsevier Science Ireland Ltd</accessCondition><recordInfo><recordContentSource>ELSEVIER</recordContentSource><recordOrigin>Elsevier Science Ireland Ltd, ©1998</recordOrigin></recordInfo></mods></metadata><enrichments><istex:catWosTEI uri="https://api.istex.fr/document/48486F5A107FF8A142E3AD62DDE149C48AAC67BB/enrichments/catWos"><teiHeader><profileDesc><textClass><classCode scheme="WOS">OBSTETRICS & GYNECOLOGY</classCode><classCode scheme="WOS">REPRODUCTIVE BIOLOGY</classCode></textClass></profileDesc></teiHeader></istex:catWosTEI></enrichments><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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