Anh Nguyen Duy, Hung Ho Sy, Sim Nguyen Thi, Ha Nguyen Thi Thu, Nguyen Duc Lam, Bac Nguyen Duy, Tong Hoang Van, Ville Yves, Thuong Phan Thi Huyen
Fetal Medicine Centre, Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam.
Hanoi Medical University, Hanoi, Vietnam.
Int J Womens Health. 2022 Apr 14;14:555-563. doi: 10.2147/IJWH.S350433. eCollection 2022.
To evaluate the surgery outcomes of fetoscopic laser ablation (FLA) for selective umbilical cord in treating twin-twin transfusion syndrome (TTTS) with special conditions and neonatal outcomes post-operation.
A prospective study, 21 monochorionic diamniotic (MCDA) twins diagnosed with TTTS stage II-IV according to Quintero classification from 16 to 26 weeks of gestation, among that, 12 cases of TTTS stage II with selective intrauterine growth restriction (sIUGR), 6 cases of TTTS stage II with proximate cord insertions, 3 cases of TTTS stage IV underwent fetoscopic laser ablation for the selective fetal reduction at Hanoi Obstetrics and Gynecology Hospital from September 2019 to July 2021. Complications and surgical outcomes were noted. Prenatal care was carried out every 2 weeks post operation until birth. Newborn neurologic complications were assessed at birth, three months, and six months after birth using Denver II test and magnetic resonance imaging (MRI).
The mean gestational age at operation was 20.30 weeks. The average operation duration was 39.52 minutes. No complications of operation, such as bleeding or infection, were recorded. The mean gestational age at birth was 34.70 ± 4.33 weeks, with a mean duration of 12.97 ± 6.87 weeks between intervention and delivery. The survival rate of newborns after the operation was 90.48%. There were two stillbirths (9.52%) within seven days after the operation. No short-term neurological complications have been reported with follow-up of the newborn to 6 months after birth.
Our study showed that fetoscopic laser ablation of selected fetal reduction surgery for treatment of special conditions of TTTS had no complications of operation, high neonatal survival result (90.48%), no short-term neurological complications. This should be considered for TTTS in cases of indication.
评估胎儿镜激光消融术（FLA）选择性减胎治疗特殊情况双胎输血综合征（TTTS）的手术效果及术后新生儿结局。
一项前瞻性研究，选取2019年9月至2021年7月在河内妇产科医院就诊的16至26周妊娠、根据Quintero分类诊断为II-IV期的21例单绒毛膜双羊膜囊（MCDA）双胎，其中12例II期TTTS合并选择性胎儿生长受限（sIUGR），6例II期TTTS合并脐带临近插入，3例IV期TTTS行胎儿镜激光消融术选择性减胎。记录并发症及手术结果。术后每2周进行产前检查直至分娩。出生时、出生后3个月和6个月使用丹佛发育筛查测验（Denver II）和磁共振成像（MRI）评估新生儿神经并发症。
手术时平均孕周为20.30周。平均手术时长为39.52分钟。未记录到手术并发症，如出血或感染。出生时平均孕周为34.70±4.33周，干预至分娩的平均时长为12.97±6.87周。术后新生儿存活率为90.48%。术后7天内有2例死产（9.52%）。对新生儿随访至出生后6个月，未报告短期神经并发症。
我们的研究表明，胎儿镜激光消融术选择性减胎治疗TTTS特殊情况无手术并发症，新生儿存活率高（90.48%），无短期神经并发症。在有指征的TTTS病例中应考虑采用该方法。
