Fetal surgery in complicated monoamniotic pregnancies: case series and systematic review of the literature. (19th March 2014)

• Record Type: Journal Article
• Authors: Peeters, Suzanne H. P.; Devlieger, Roland; Middeldorp, Johanna M.; DeKoninck, Philip; Deprest, Jan; Lopriore, Enrico; Lewi, Liesbeth; Klumper, Frans J.; Kontopoulos, Eftichia; Quintero, Ruben; Oepkes, Dick
• Is Part Of: Prenatal diagnosis. Volume 34:Number 6(2014:Jun.)
• Page Start: 586
• Page End: 591
• Publication Date: 2014-03-19
• Subjects: Prenatal diagnosis -- Periodicals; Fetus -- Diseases -- Diagnosis -- Periodicals; Electronic journals; 618.32075
• DOI: 10.1002/pd.4353
• Languages: English
• ISSNs: 0197-3851

Abstract

<abstract abstract-type="main"> <title>ABSTRACT</title> <sec id="pd4353-sec-0001" sec-type="section"> <title>Objective</title> <p>This study aimed to analyze perinatal outcome in monoamniotic (MA) pregnancies that underwent antenatal surgical interventions for fetal complications.</p> </sec> <sec id="pd4353-sec-0002" sec-type="section"> <title>Methods</title> <p>Review of all MA pregnancies treated with antenatal surgical interventions in three fetal treatment centers between 2000 and 2013. Indications were twin–twin transfusion syndrome, twin reversed arterial perfusion sequence, discordant anomalies, or elective reduction. We analyzed associations between indication, type of intervention, perinatal survival, and gestational age (GA) at birth and compared our results with a systematic review of the literature.</p> </sec> <sec id="pd4353-sec-0003" sec-type="section"> <title>Results</title> <p>Fifty‐eight MA pregnancies were included. Median GA at treatment was 18.0 weeks (range: 13.1–33.0). Procedures included cord coagulation plus transection (<italic>n</italic> = 42), cord coagulation without transection (<italic>n</italic> = 7), laser coagulation of placental anastomoses (<italic>n</italic> = 7), and one case each with interstitial laser and radiofrequency ablation. Median GA at birth was 34 weeks (range 16.0–41.0), and 75% (53/71) of fetuses intended to survive indeed survived. Literature review included 20 articles, reporting on a total of 45 cases of surgically treated MA pregnancies, showing similar outcome results.</p> </sec> <sec id="pd4353-sec-0004" sec-type="section"> <title>Conclusion</title> <p>We present the largest series concerning surgical interventions in complicated MA pregnancies. Despite being rare in experienced hands, a 75% survival is achieved. Collaboration between centers, data sharing, and benchmarking may further improve outcome. © 2014 John Wiley & Sons, Ltd.</p> </sec> </abstract>