经阴道镜激光消融术治疗 II 型帆状胎盘前置血管。

Fetoscopic Laser Ablation Therapy for Type II Vasa Previa.

机构信息

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA,

San Diego Perinatal Center, Rady Children's Specialists of San Diego, San Diego, California, USA.

出版信息

Fetal Diagn Ther. 2020;47(9):682-688. doi: 10.1159/000508044. Epub 2020 Jul 6.

DOI:10.1159/000508044

PMID:32629451

Abstract

BACKGROUND

In type II vasa previa, fetoscopic laser ablation has the potential to avoid prolonged hospitalization, elective prematurity, and cesarean delivery associated with traditional conservative management.

OBJECTIVE

To assess the feasibility and to report perinatal outcomes of type II vasa previa patients treated via fetoscopic laser ablation.

STUDY DESIGN

This is a retrospective descriptive study of all women with vasa previa treated with laser at our center between 2006 and 2019. After 2010, laser ablation of vasa previa was only offered after 31 gestational weeks. Continuous variables are expressed as means ± SD.

RESULTS

33 patients were evaluated for laser ablation of suspected vasa previa. Fifteen were not candidates (7 had type I vasa previa and 8 had no vasa previa), and the 18 remaining had type II vasa previa. Ten (56%) elected to undergo in utero laser ablation of the vasa previa vessel(s), which was successful in all patients. The mean gestational age (GA) at the time of the procedure was 28.8 ± 5.4 weeks, and the total operative time was 48.1 ± 21.3 min; there were no perioperative complications. The number of vessels lasered were distributed as follows: 1 (2 cases), 2 (5 cases), and 3 (3 cases). All patients except for 1 were subsequently managed as outpatients. The mean GA at delivery was 35.5 ± 3.2 weeks, and vaginal delivery occurred in 5 cases. The 5 patients with singletons who underwent laser ablation for primary diagnosis of type II vasa previa after the protocol change in 2010 had the following outcomes: mean GA of surgery was 32.5 ± 0.8 weeks, mean GA at delivery was 38.1 ± 1.4 weeks, vaginal delivery occurred in all cases, mean birth weight was 2,965 ± 596 g, and none were admitted to the neonatal intensive care unit.

CONCLUSION

This cohort represents the largest number of vasa previa cases treated via in utero laser reported to date. Laser occlusion of type II vasa previa was technically achievable in all cases and resulted in favorable outcomes.

摘要

背景

在 II 型帆状胎盘前置中，胎儿镜激光消融术有可能避免与传统保守治疗相关的长时间住院、择期早产和剖宫产。

目的

评估 II 型帆状胎盘前置患者接受胎儿镜激光消融术的可行性，并报告围产期结局。

研究设计

这是一项对 2006 年至 2019 年期间在我们中心接受激光治疗的所有帆状胎盘前置患者的回顾性描述性研究。2010 年后，仅在 31 孕周后才提供激光消融术治疗。连续变量表示为平均值±标准差。

结果

对 33 例疑似帆状胎盘前置患者进行了激光消融评估。其中 15 例不符合条件（7 例为 I 型帆状胎盘前置，8 例无帆状胎盘前置），其余 18 例为 II 型帆状胎盘前置。10 例（56%）选择进行宫内激光消融胎盘血管，所有患者均成功。手术时的平均孕周（GA）为 28.8±5.4 周，总手术时间为 48.1±21.3 分钟；无围手术期并发症。激光消融的血管数量分布如下：1 根（2 例）、2 根（5 例）和 3 根（3 例）。除 1 例外，所有患者随后均作为门诊患者管理。分娩时的平均 GA 为 35.5±3.2 周，5 例经阴道分娩。在 2010 年方案改变后，因 II 型帆状胎盘前置的初诊而接受激光消融的 5 例单胎患者的结局如下：手术时的平均 GA 为 32.5±0.8 周，分娩时的平均 GA 为 38.1±1.4 周，所有病例均经阴道分娩，平均出生体重为 2965±596g，无新生儿入住新生儿重症监护病房。