Premium
P12.04: Feasibility of fetal myelomeningocele repair through a 1.5–2.5cm mini hysterotomy
Author(s) -
CruzMartinez R.,
MartinezRodriguez M.,
GamezVarela A.,
LunaGarcía J.,
CasteloVargas A.,
AguilarVidales K.,
Ochoa F. Chavelas
Publication year - 2019
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.20990
Subject(s) - hysterotomy , medicine , spina bifida , fetus , fetal surgery , surgery , gestational age , obstetrics , gestation , pregnancy , in utero , genetics , biology
Objectives: To investigate the perinatal outcomes of complicated monochorionic twins undergoing selective reduction by radiofrequency ablation. Methods: We analysed 220 consecutive cases of complicated monochorionic twins selectively reduced by ultrasound-guided RFA from July 2013 to September 2018 in the Fetal Medical Center of Guangzhou Medical University. The clinical data were recorded in detail in Astraia database. The factors affecting the perinatal outcomes are analysed. Results: Among 220 cases, the indications of reduction were: reducing fetal numbers (21/220, 10.0%), discordant structural abnormalities (59/220, 27.0%), discordant chromosomal abnormalities (3/220, 1.0%), twin to twin transfusion syndrome (71/220, 32.0%), selective intrauterine growth restriction (56/220, 26.0%), twin reversed arterial perfusion sequence (7/220, 3.0%) and twin anemia-polycythemia sequence (3/220, 1.0%). The mean gestational age in operation is 20.1 ± 3.3 weeks. The median cervical length is 34.6mm. The umbilical cord blood flow is completely occluded after 1 to 3 cycles in 198 cases, after four cycles in 10 cases and after five cycles in 12 cases. All operations are technically successful. In all 220 cases, fetal demise occurred in 48 cases. 172 cases were live birth (172/220, 78.2%). The median gestational age of delivery is 34 week (26-41 week); the mean birth weight is 2637 ± 774g. The preterm birth rate before 34 weeks is 19.8% (34/172) and before 37 week is 23.3% (40/172). Cervical length≤35 mm was significantly associated with lower live birth rate, higher fetal loss rate and preterm birth (< 34 week) rate (P < 0.05). There was a significant reverse relationship between the number of cycles with the fetal loss rate (P < 0.05). Conclusions: In complicated monochorionic twins undergoing selective reduction by RFA, the perinatal outcomes of survival are effectively improved. Cervical length is a predictor of the premature birth rate. The number of cycles of ablation is reversely associated with the fetal loss rate.