Evaluation of Laparotomy With Trans-Amniotic Suture Placement in TTTS Surgery
Children's Hospital Medical Center, Cincinnati
Summary
This is a randomized trial for patients that are diagnosed with Twin-Twin Transfusion Syndrome (TTTS) who are receiving a fetoscopic laser surgery to evaluate the effectiveness and safety of a laparotomy closure.
Description
The rationale behind suturing the hole is that the amniotic membrane does not close itself, rather you are relying that the uterus closes over the hole in the amniotic membrane, which may or may not happen, as well as in fetoscopic surgery for another condition, myelomeningocele. Published data has shown that maternal laparotomy to suture closure of the port site at the time of fetoscopic surgery leads to improved pregnancy outcomes, later gestational age at delivery, and lower rates of preterm pre-labor rupture of membranes (PPROM) \[PMID: 28910784\].
Eligibility
- Age range
- 18+ years
- Sex
- Female
- Healthy volunteers
- No
Inclusion Criteria: * Diagnosis of TTTS or Twin Anemia-Polycythemia Sequence (TAPS) * Gestational age between 18 weeks and 23 weeks (18 0/7 to 22 6/7 weeks) * Cervical length \>2.5 cm preoperatively * Identification of a safe percutaneous surgical window by a provider experienced in fetoscopic surgery prior to entering the operating room Exclusion Criteria: * Higher order pregnancies, chromosomal or severe congenital anomalies, undergoing laser surgery for fetal growth restriction only, need for a second laser during pregnancy, failure to complete laser, PPROM prior to surgery. BMI\> 40 at…
Interventions
- OtherTrans-Amniotic Suture Placement
Trans-Amniotic Suture placement
Location
- Cincinnati Childrens Hospital Medical CenterCincinnati, Ohio