Laser Photocoagulation of Communicating Vessels in Twin-to-Twin Transfusion Syndrome (TTTS)
Seattle Children's Hospital
Summary
The purpose of this study is to evaluate the use of diode laser photocoagulation of the communicating vessels in twin-to- twin transfusion syndrome (TTTS) with respect to maternal, fetal and neonatal outcomes.
Description
Patients will undergo an intake evaluation followed by a detailed ultrasound examination to rule out the presence of congenital anomalies and to assess the hemodynamic status of the fetuses and any pre-existing cerebral damage. The following data will be collected, as is identical to the standard of care in evaluating monochorionic twins Maternal * Age * Gravidity and parity * BMI * Race/ethnicity * Gestational age * The presence of any symptoms * Cervical length Fetal * Estimated fetal weight * Detailed anatomy * Doppler evaluation of umbilical cord, ductus venosus and middle cerebral art…
Eligibility
- Age range
- Not specified
- Sex
- Female
- Healthy volunteers
- No
Inclusion Criteria: * Single placenta (Monochorionic) * Polyhydramnios present in recipient twin (Greater than 8 cm maximum vertical pocket below 20 weeks and greater than a 10 cm pocket for greater than 20 weeks gestational age) * Oligohydramnios present in donor twin (Less than 2 cm maximum vertical pocket) * Prominent bladder in the recipient/ non-filling bladder in the donor * Thin dividing membrane Exclusion Criteria: * Patients unwilling to participate in the study or to be followed up * Presence of major congenital anomalies incompatible with survival * Active pre-term labor Ruptured…
Interventions
- ProcedureFetoscopic laser ablation
Under ultrasound guidance, a 2 mm skin incision will be made and a 10Fr Cook Check Flow valve cannula and trocar will be introduced into the amniotic cavity. The communicating vessels will be located endoscopically using a Storz straight or curved semirigid fetoscopes in a fetoscopic sheath, a Humanitarian Use Device, used with permission of the Federal Drug Administration under a Humanitarian Device Exemption agreement with Karl Storz, Inc, and will be ablated with a diode laser fiber that is passed through the operating channel of the endoscope.
Locations (2)
- Seattle Childrens HospitalSeattle, Washington
- University of WashingtonSeattle, Washington