4 years ago

Intrafetal laser for embryo reduction from dichorionic triplets to dichorionic twins

Kypros H. Nicolaides, Petya Chaveeva, Savino Gil Pugliese, Atanas Shterev, Gergana Peeva
Objective To report the outcome of dichorionic (DC) triplet pregnancies reduced to DC twins by laser ablation of the pelvic vessels of one of the monochorionic twins. Methods Intrafetal laser embryo reduction (ER) from DC triplet to DC twins was carried out in 61 pregnancies at 11+0 - 14+3 weeks' gestation. Pregnancy outcome was examined and compared to previous studies in DC triplets managed expectantly or by ER to twins or singleton with fetal intracardiac injection of potassium chloride (KCl). Results Intrafetal laser was successfully carried out in all cases, but, ultrasound examination within two weeks of the procedure demonstrated that the co-twin had died in 28 (45.9%) cases and was alive in the other 33 (54.1%). In the DC group there was one miscarriage at 23 weeks, one neonatal death after delivery at 26 weeks and in the other 31 cases there were two live births at a median gestational age of 35.3 (range 30.4-38.4) weeks. In the 28 cases where both monochorionic fetuses died there was one miscarriage at 16 weeks and in the other 27 cases the separate triplet was live born at a median gestation of 38.2 (range 32.2-42.1) weeks. In DC triplets intrafetal laser was associated with lower rate of miscarriage (3%), compared to that with expectant management (9%) or ER by intracardiac injection of KCl to monochorionic twins (13%) or singleton (18%). The rate of preterm birth (PTB) at <33 weeks (9%) was also lower than with expectant management (38%) or ER by KCl to monochorionic twins (23%), but the same as with ER to singleton (9%). Conclusions In the management of DC triplet pregnancies, ER to DC twins by intrafetal laser is associated with lower rates of miscarriage or early PTB, compared to expectant management or ER by KCl. However, about half of the pregnancies result in the birth of one rather than two babies.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/uog.18834

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