Abstract | OBJECTIVE: STUDY DESIGN: RESULTS: Thirty patients met the criteria for the study: 17 patients were treated expectantly (group I); 2 patients underwent umbilical-cord ligation of the twin with selective intrauterine growth retardation, and 11 patients underwent selective laser photocoagulation of the communicating vessels (group II). Survival rates for at least 1 fetus were no different between groups I and II (14/17 [82.3%] vs 8/11 [72.3%]; P = .4). However, concomitant demise of the co-twin occurred in 4 of 7 patients, and iatrogenic premature delivery for deterioration of the twin with selective intrauterine growth retardation was necessary in 2 patients in group I, which resulted in significant neonatal morbidity. Of the live-born babies, neurologic handicap was present in 3 of 22 babies (13.6%) versus 0 of 12 in groups I and II, respectively (P < .0001). CONCLUSION: Selective intrauterine growth retardation in monochorionic twins can be effectively treated with selective laser photocoagulation of the communicating vessels. By unlinking the circulations between the fetuses, the pregnancy is rendered "functionally" dichorionic, which improves pregnancy treatment and results in decreased neonatal morbidity. This approach constitutes a new valuable alternative in the treatment of monochorionic twin pregnancies with selective intrauterine growth retardation. A randomized clinical trial of expectant treatment versus selective laser photocoagulation of the communicating vessels for monochorionic selective intrauterine growth retardation can be considered.
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Authors | R A Quintero, P W Bornick, W J Morales, M H Allen |
Journal | American journal of obstetrics and gynecology
(Am J Obstet Gynecol)
Vol. 185
Issue 3
Pg. 689-96
(Sep 2001)
ISSN: 0002-9378 [Print] United States |
PMID | 11568799
(Publication Type: Journal Article)
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Topics |
- Blood Vessels
(embryology)
- Delivery, Obstetric
- Diseases in Twins
- Female
- Fetal Death
- Fetal Growth Retardation
(embryology, surgery, therapy)
- Fetofetal Transfusion
(surgery)
- Fetus
(surgery)
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases
(epidemiology)
- Ligation
- Light Coagulation
- Morbidity
- Pregnancy
- Pregnancy Outcome
- Referral and Consultation
- Survival Analysis
- Twins, Monozygotic
- Umbilical Cord
- Vascular Surgical Procedures
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