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.
Url:
DOI: 10.1016/S0301-2115(98)00181-X
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<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>
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<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>
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<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>
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</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>
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<mods version="3.6"><titleInfo><title>Experience with fetoscopic cord ligation</title>
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<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>
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<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>
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<titleInfo type="abbreviated"><title>EURO</title>
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<originInfo><dateIssued encoding="w3cdtf">19981201</dateIssued>
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<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>
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<detail type="issue"><number>2</number>
<caption>no.</caption>
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<extent unit="issue pages"><start>133</start>
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<identifier type="DOI">10.1016/S0301-2115(98)00181-X</identifier>
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<accessCondition type="use and reproduction" contentType="copyright">©1998 Elsevier Science Ireland Ltd</accessCondition>
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