Type II and III selective fetal growth restriction: perinatal outcomes of expectant management and laser ablation of placental vessels

OBJECTIVES: To describe the perinatal outcomes of type II and III selective fetal growth restriction (sFGR) in monochorionic-diamniotic (MCDA) twin pregnancies treated with expectant management or laser ablation of placental vessels (LAPV). METHODS: Retrospective analysis of cases of sFGR that received expectant management (type II, n=6; type III, n=22) or LAPV (type II, n=30; type III, n=9). The main outcomes were gestational age at delivery and survival rate. RESULTS: The smaller fetus presented an absent/reversed "a" wave in the ductus venosus (arAWDV) in all LAPV cases, while none of the expectant management cases presented arAWDV. The median gestational age at delivery was within the 32nd week for expectant management (type II and III) and for type II LAPV, and the 30th week for type III LAPV. The rate of at least one twin alive at hospital discharge was 83.3% and 90.9% for expectant management type II and III, respectively, and 90% and 77.8% for LAPV type II and III, respectively. CONCLUSION: LAPV in type II and III sFGR twins with arAWDV in the smaller fetus seems to yield outcomes similar to those of less severe cases that received expectant management.

A study of placental vascular pattern by corrosive cast in Gujarat Region.

Introduction: A study of placental vasculature pattern was undertaken by using corrosion cast technique. The placenta is a highly vascularised organ. In this study we aimed to elucidate the structure of the cotyledonary vasculature of the human placenta after delivery, which serves as a core for the shape of the whole foetal villosity. Material & Method: Appropriate cast material was injected through placental vessels to form a corrosion cast model of placental blood vessels which was followed by meticulous dissection. Results: The cast models demonstrated very well the Hyrtl anastomosis between the umbilical arteries in the vicinity of the umbilical cord insertion into the placenta but no extra-placental anastomosis found between umbilical artery and umbilical vein. The chorionic vasculature exhibits a combination of the dichotomous and monopodial patterns. The chorionic vessels branch through 6 to 8 generations from the cord insertion towards the margins of the chorionic plate. The vein bifurcated twice immediately after insertion into the placenta. Conclusion: 3-dimensional structure of placenta can be demonstrated by micro vascular casts which reflect the shape of the whole or part of the organ, and include specific details such as the capillary architectural structure. Macroscopic visualisation can technically be advanced in 3 ways: treatment of maternal and fetal circulatory systems in common or each of the 2 systems separately.

Retrospective analysis of fetoscopic photocoagulation of communicating placental vessels of twin-twin transfusion syndrome / 第三军医大学学报

Objective To investigate the effect of fetoscopic photocoagulation of communicating placental vessels in twin-twin transfusion syndrome(TTTS)(selective or non-selective) on the perinatal outcomes.Methods Six cases of TTTS admitted in our department from Dec.2006 to Jun.2008 underwent fetoscopic photocoagulation of communicating vessels.Under direct real-time sonographic guidance,a 3-mm-diameter fetoscope was percutaneously inserted through the maternal abdominal wall into the amniotic cavity of the recipient twin.A combination of ultrasonographic and fetoscopic vision was used to identify the crossing vessels which were systematically coagulated using Nd:YAG laser fiber or bipolar electrocoagulation.Results All the 6 mothers tolerated the procedure without major complications.Two fetal survival rate was 33.33%.Conclusion Fetoscopic photocoagulation of communicating placental vessels in TTTS can effectively improve perinatal outcomes.