2,685 results match your criteria Twin-to-Twin Transfusion Syndrome


Fetal Growth in Multiple Gestations: Evaluation and Management.

Obstet Gynecol Clin North Am 2021 Jun;48(2):401-417

Division of Maternal-Fetal Medicine, University of Colorado, Children's Hospital Colorado, Colorado Fetal Care Center, 12631 East 17th Avenue, Box B198-5, Aurora, CO 80045, USA.

Multifetal gestation pregnancies present a clinical challenge due to unique complications including growth issues, prematurity, maternal risk, and pathologic processes, such as selective intrauterine growth restriction (sIUGR), twin-to-twin transfusion syndrome (TTTS), and twin anemia-polycythemia sequence. If sIUGR is found, then management may involve some combination of increased surveillance, fetal procedures, and/or delivery. The combination of sIUGR with TTTS or other comorbidities increases the risk of pregnancy complications. Read More

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Genetic Profiling of Idiopathic Antenatal Intracranial Haemorrhage: What We Know?

Genes (Basel) 2021 Apr 15;12(4). Epub 2021 Apr 15.

Department of Obstetrics and Gynaecology, Santo Eugenio Hospital, ASL Roma 2, 00100 Rome, Italy.

Intracranial hemorrhage (ICH) is reported in premature infants and rarely, in prenatal life. Fetal ICH can be accurately identified in utero and categorized by antenatal sonography and/or MRI. Infectious disease, maternal drug exposure, alloimmune thrombocytopenia, maternal trauma, coagulation disorders and twin-to-twin transfusion syndrome can cause fetal ICH. Read More

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Feasibility of fetal left modified myocardial performance index in twin anemia polycythemia sequence and perinatal outcomes after antenatal intervention.

J Matern Fetal Neonatal Med 2021 Apr 28:1-8. Epub 2021 Apr 28.

Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.

Objective: To evaluate the feasibility and clinical value of fetal left modified myocardial performance index (Mod-MPI) in assessment and management of prenatal twin anemia polycythemia sequence (TAPS).

Methods: We retrospectively reviewed fetuses with TAPS diagnosed prenatally between 2015 and 2019 at Asan Medical Center. Doppler ultrasound evaluation including the peak systolic velocity (PSV) of the middle cerebral artery (MCA) and fetal echocardiography including left Mod-MPI were evaluated and followed up after antenatal management. Read More

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Risk Profiling of the Solomon Technique versus Selective Technique of Fetoscopic Laser Surgery for Twin-Twin Transfusion Syndrome.

Twin Res Hum Genet 2021 Feb;24(1):42-48

Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.

We evaluated the outcomes and adverse events after fetoscopic laser surgery (FLS) for twin-twin transfusion syndrome (TTTS) using the Solomon technique in comparison to the selective technique. A retrospective analysis of a single-center consecutive cohort of FLS-treated TTTS using the selective (January 2010 to July 2014) and Solomon (August 2014 to December 2017) techniques was performed. Among 395 cases, 227 underwent selective coagulation and 168 underwent the Solomon technique. Read More

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February 2021

Prevalence of umbilical artery Doppler waveform abnormality during the early second trimester and the subsequent variation of waveforms in monochorionic diamniotic twin pregnancies: A prospective cohort study.

J Obstet Gynaecol Res 2021 Apr 25. Epub 2021 Apr 25.

Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan.

Aim: To investigate the prevalence of qualitative abnormal umbilical artery Doppler waveforms (Abnormal UA) during the early second trimester and the subsequent variation of waveforms in monochorionic diamniotic (MCDA) twin pregnancies.

Methods: This prospective cohort study included 153 MCDA twin pregnancies. Pulsed Doppler examinations for UA were performed at four points, including the free-loop (FL) and near the placental cord insertion site (CI) of each UA, between 16 and 17 weeks' gestation. Read More

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Comparison of the ratio of placental territory discordance to birthweight discordance in placentas of monochorionic diamniotic twins.

Sci Prog 2021 Apr-Jun;104(2):368504211010595

Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.

The ratio of placental territory discordance to birthweight discordance was calculated in monochorionic diamniotic twin placentas. We then determined whether the ratio: (1) correlated with the overall diameter of the placental superficial vascular anastomoses and (2) was different in normal monochorionic diamniotic twin (normal MCDA), twin-to-twin transfusion syndrome (TTTS), and selective intrauterine growth restriction (sIUGR) pregnancies. A prospective study of MCDA placentas was conducted from April 1, 2016, to April 1, 2019, including three groups, normal MCDA ( = 49), TTTS ( = 38), and sIUGR ( = 52). Read More

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Perinatal outcomes and factors affecting the survival rate of fetuses with twin-to-twin transfusion syndrome treated with fetoscopic laser coagulation: a single-center seven-year experience.

J Matern Fetal Neonatal Med 2021 Apr 20:1-12. Epub 2021 Apr 20.

Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Republic of Korea.

Objectives: This single-center study aimed to assess the perinatal outcomes and its associated factors in fetuses with twin-to-twin transfusion syndrome (TTTS) treated by fetoscopic laser coagulation (FLC).

Methods: In this retrospective study, we included fetuses prenatally diagnosed with TTTS at Asan Medical Center, Seoul, Korea, between October 2011 and December 2018. All patients with TTTS stage II or higher and those with stage I TTTS coupled with symptomatic polyhydramnios or cardiac dysfunction were eligible for FLC. Read More

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[Effect of placental vascular distribution on residual anastomoses after fetoscopic laser surgery for twin to twin transfusion syndrome].

Zhonghua Fu Chan Ke Za Zhi 2021 Mar;56(3):171-177

Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.

To investigate the effect of placental vascular distribution on residual anastomoses (RA) after fetoscopic laser occlusion of chorioangiopagous ressels (FLOC) for twin to twin transfusion syndrome (TTTS). A total of 57 cases of TTTS after laser surgery were retrospectively analyzed from April 2014 to April 2019 in Peking University Third Hospital. The patients were divided into RA group (24 cases) and non-RA group (33 cases) according to whether RA occurred in the placenta after laser surgery. Read More

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Spectral Doppler, tissue Doppler, and speckle-tracking echocardiography for the evaluation of fetal cardiac function: an update.

Radiol Bras 2021 Mar-Apr;54(2):99-106

Department of Obstetrics, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.

The functional assessment of the fetal heart has been incorporated into cardiac ultrasound screening as a routine procedure, encompassing fetuses with and without structural heart diseases. It has long been known that various cardiac and extracardiac conditions, such as fetal growth restriction, fetal tumors, twin-to-twin transfusion syndrome, fetal anemia, diaphragmatic hernia, arteriovenous fistula with high cardiac output, and congenital heart diseases (valvular regurgitation and primary myocardial disease), can alter hemodynamic status and fetal cardiac function. Several ultrasound and Doppler echocardiographic parameters of fetal cardiovascular disease have been shown to correlate with perinatal mortality. Read More

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Complicated Monochorionic-Diamniotic Twins in a Pregnant Woman with COVID-19 in the Second Trimester.

Am J Perinatol 2021 Apr 14. Epub 2021 Apr 14.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California.

Objective:  A majority of studies evaluating the risk of vertical transmission and adverse outcomes in pregnancies with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are mostly based on third-trimester infections. There is limited data available on pregnancy sequelae of maternal infection in the first or second trimester.

Study Design:  We present a patient with monochorionic-diamniotic twins that develops coronavirus disease 2019 infection at 15 weeks of gestation. Read More

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Fetoscopic laser ablation in twin-to-twin transfusion syndrome: tips for counselling.

Minerva Obstet Gynecol 2021 Apr;73(2):247-252

Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy.

Twin-to-twin transfusion syndrome (TTTS) is a serious complication that affects approximately 10-15% of monochorionic twin pregnancies. The most important role for the development of this condition is the presence of an unbalanced flow through the inter-twin vascular anastomoses. Depending on the number, type and direction of the connecting vessels, blood can be transfused disproportionately from one twin (the donor) to the other twin (the recipient). Read More

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Predicting fetal and neonatal demise after fetoscopy for twin-twin transfusion syndrome using recursive partitioning.

Prenat Diagn 2021 Apr 13. Epub 2021 Apr 13.

Department of Obstetrics, Gynecology and Reproductive Sciences, The University of Texas Health Science Center at Houston John P and Katherine G McGovern Medical School, Fetal Center at Children's Memorial Hermann Hospital, Houston, Texas, USA.

Objective: Donor demise after laser surgery for twin-twin transfusion syndrome (TTTS) is well-characterized, but recipient demise is not, nor is neonatal death. This study aims to characterize factors associated with recipient death, donor death, and dual twin death after laser, both before and after birth.

Methods: This is a prospective cohort study of monochorionic twin pairs who underwent laser ablation for TTTS. Read More

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A case of total hysterectomy due to massive maternal bleeding immediately after fetoscopic laser surgery for twin-twin transfusion syndrome.

J Obstet Gynaecol Res 2021 Apr 11. Epub 2021 Apr 11.

Department of Obstetrics and Gynecology, Yamaguchi University Graduate School of Medicine, Ube, Japan.

Twin-twin transfusion syndrome (TTTS) complicates approximately 10% of monochorionic twin pregnancies and is associated with almost 90% mortality if left untreated. Fetoscopic laser photocoagulation (FLP) is the first-line therapy for TTTS, and an overall twin survival rate of 75% and at least one survival rate of 90% have been established. We report a case of TTTS complicated with bleeding from the uterine wall by inserting the procedure after FLP. Read More

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The Detection, Outcome, and Presentation of Twin-Twin Transfusion Syndrome in Monochorionic Diamniotic Twin Pregnancies Followed with a Protocol of Fortnightly Ultrasound Examination.

Fetal Diagn Ther 2021 Apr 6:1-8. Epub 2021 Apr 6.

Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium.

Background: Evidence to support a fortnightly scan protocol for monochorionic diamniotic (MCDA) pregnancies to detect twin-twin transfusion syndrome (TTTS) is scarce. Also, TTTS-related mortality in an unselected cohort is not well documented. Finally, common knowledge suggests that a more frequent follow-up may pick up the disease at a milder stage, but little is known on the ultrasound findings before the diagnosis. Read More

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Twin-to-Twin Transfusion Syndrome: Diagnostic Imaging and Its Role in Staving Off Malpractice Charges and Litigation.

Diagnostics (Basel) 2021 Mar 4;11(3). Epub 2021 Mar 4.

Department of Anatomical, Histological, Forensic, and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy.

The study aims to expound upon the imaging-based diagnostic methodologies aimed at identifying twin-to-twin transfusion syndrome (TTTS), a serious, somewhat rare prenatal condition that takes place in pregnancies where identical twins, or other multiples, share a placenta (monochorionic placenta), highlighting how medico-legal outcomes can be affected by provable compliance with consolidated diagnostic guidelines or best practices. It is of utmost importance to produce a prompt identification of TTTS instances; an early diagnosis is in fact critical in order to effectively treat and manage TTTS. By virtue of TTTS being a highly progressive condition, a delay in diagnosis can result in disastrous outcomes; just a few weeks delay in the diagnosis of TTTS can turn out fatal for one or both twins. Read More

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Twin-To-Twin Transfusion Syndrome Donor and Recipient and Their Subsequent Cognitive Functioning in Late Childhood as Juvenile Athletes-A Case Study.

Int J Environ Res Public Health 2021 03 4;18(5). Epub 2021 Mar 4.

Institute of Psychology, Faculty of Social Sciences, University of Gdansk, 80-309 Gdansk, Poland.

: It is estimated that twin-to-twin transfusion syndrome (TTTS) occurs in 10-15% of monochorionic twin pregnancies. One of the fetuses takes on the role of donor and the other of recipient. The treatment administered involves serial amnioreduction and laser photocoagulation of the communicating blood vessels. Read More

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Review of International Clinical Guidelines Related to Prenatal Screening during Monochorionic Pregnancies.

J Clin Med 2021 Mar 8;10(5). Epub 2021 Mar 8.

Department of Family and Community Medicine, Northeast Ohio Medical University, 4209 State Route 44, P.O. Box 95, Rootstown, OH 44272, USA.

We conducted a search for international clinical guidelines related to prenatal screening during monochorionic pregnancies. We found 25 resources from 13 countries/regions and extracted information related to general screening as well as screening related to specific monochorionic complications, including twin-twin transfusion syndrome (TTTS), selective fetal growth restriction (SFGR), and twin anemia-polycythemia sequence (TAPS). Findings reveal universal recommendation for the early establishment of chorionicity. Read More

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Perioperative Care of Patients Diagnosed With Twin-to-Twin Transfusion Syndrome Undergoing Laparoscopic-Assisted Fetoscopic Placental Laser Photocoagulation.

AORN J 2021 04;113(4):361-372

Twin-to-twin transfusion syndrome (TTTS) is a condition that results in unbalanced blood flow between two fetuses. Patients diagnosed with TTTS can experience maternal or fetal morbidity and mortality. Depending on the severity of TTTS, laser ablation of placental anastomoses may be the most effective treatment. Read More

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Perinatal outcome of twin-to-twin transfusion syndrome complicated with incidental septostomy after laser photocoagulation: A systematic review and meta-analysis.

Prenat Diagn 2021 Mar 29. Epub 2021 Mar 29.

Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, USA.

Aim: To evaluate perinatal outcomes of incidental septostomy (IS) after laser photocoagulation for twin-to-twin transfusion syndrome (TTTS), and to compare the outcomes with those who had intact intertwin membrane.

Methods: Databases such as PubMed, Web of Science, Scopus, and Embase were systematically searched from inception up to August 2020. The random-effects model was used to pool the mean difference (MD) or odds-ratio (OR) with the corresponding 95% confidence intervals (CIs). Read More

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Twin Anemia Polycythemia Sequence in a Dichorionic Twin Pregnancy Leading to Severe Cerebral Injury in the Recipient.

Fetal Diagn Ther 2021 26;48(4):321-326. Epub 2021 Mar 26.

Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.

Twin anemia polycythemia sequence (TAPS) is a form of chronic imbalanced feto-fetal transfusion through minuscule placental anastomoses leading to anemia in the TAPS donor and polycythemia in the TAPS recipient and has been reported only in monochorionic twins. We report a very unusual case of TAPS which developed in a dichorionic twin pair, born at a gestational age of 33+2. Twin 1 (recipient) was polycythemic and had a hemoglobin value of 22. Read More

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The mystery of monozygotic twinning II: What can monozygotic twinning tell us about Amyoplasia from a review of the various mechanisms and types of monozygotic twinning?

Authors:
Judith G Hall

Am J Med Genet A 2021 Jun 25;185(6):1822-1835. Epub 2021 Mar 25.

University of British Columbia and Children's and Women's Health Centre of British Columbia, Department of Pediatrics and Medical Genetics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.

Monozygotic (MZ) twins ("identical twins") are essentially unique to human beings. Why and how they arise is not known. This article reviews the possible different types of MZ twinning recognized in the previous article on twins and arthrogryposis. Read More

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Authors' reply to: Letter to the Editor in response to 'Parental attachment and depressive symptoms in pregnancies complicated by twin-twin transfusion syndrome: a cohort study'.

BMC Pregnancy Childbirth 2021 Mar 22;21(1):241. Epub 2021 Mar 22.

Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.

In this correspondence we thank the authors for highlighting the importance of our work, and agree with the limitations they have raised regarding performing this study. Read More

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Letter to the Editor in response to 'Parental attachment and depressive symptoms in pregnancies complicated by twin-twin transfusion syndrome: a cohort study'.

BMC Pregnancy Childbirth 2021 Mar 22;21(1):242. Epub 2021 Mar 22.

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, American University of Beirut, Beirut, Lebanon.

Twin-twin transfusion syndrome is a highly morbid condition that can affect parental attachment and depression risk. Studies addressing this rare condition are hard to conduct and thus lacking in the literature. In this letter to the editor, we acknowledge the article of Mackie et al. Read More

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Twin-twin transfusion syndrome is associated with alterations in the metabolic profile of maternal plasma in early gestation: a pilot study.

Prenat Diagn 2021 Mar 15. Epub 2021 Mar 15.

Institute of Metabolism and System Research, University of Birmingham, Birmingham, UK.

Objective: Twin-twin transfusion syndrome (TTTS) causes perinatal mortality and morbidity in monochorionic twins. The early recognition of and interventional therapy for TTTS is associated with a more favorable overall prognosis. However, the prediction by the use of ultrasound in the first trimester has relatively poor sensitivity and specificity. Read More

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Fetal surgery.

Authors:
K Sampat P D Losty

Br J Surg 2021 Mar 15. Epub 2021 Mar 15.

Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK.

Fetal medicine is a super-specialty enterprise and a technology-driven field. The growth and interest in fetal surgery can be largely attributed to advances in fetal imaging and bespoke instruments for in utero intervention. Previously fatal fetal conditions are now being treated using open surgery, minimally invasive procedures, and percutaneous fetal technologies. Read More

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A novel "video-game" simulator for training fetoscopic laser coagulation of anastomoses in twin-to-twin transfusion syndrome.

Prenat Diagn 2021 Mar 11. Epub 2021 Mar 11.

Division of Maternal Fetal Medicine, Ontario Fetal Centre at Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.

We have developed a high-fidelity interactive "video-game" simulator in order to teach fetoscopic laser ablation of placental anastomoses for twin-twin transfusion syndrome This simulator may be used by teachers in order to provide metrics-based simulator education to multiple trainees, in both hands-on and distanced learning settings WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: The use of simulation improves training of the fetoscopic laser techniques utilized in the treatment of twin-twin transfusion syndrome A number of mannequins have been developed to aid this education WHAT DOES THIS STUDY ADD?: Two new simulators are described for twin-twin transfusion syndrome training-silicone and digital The digital simulator is a novel digital video game virtual format This new format has enhanced interactivity and has the potential to enable distance learning. Read More

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Double inferior vena cava in a monochorionic twin pregnancy with selective fetal growth restriction.

BMJ Case Rep 2021 Mar 10;14(3). Epub 2021 Mar 10.

Department for Obstetrics and Gynecology, Inselspital Bern Universitätsklinik für Frauenheilkunde, Bern, BE, Switzerland.

Congenital anomalies of the infrarenal inferior vena cava (IVC) are well described in adult life, however, little information exists on their associations in fetal life. Here, we describe a case of a monochorionic diamniotic (MCDA) twin pregnancy complicated by selective fetal growth restriction (sFGR) with an incidental finding of a double IVC in one child. In fetal life, variants of the infrarenal IVC are strongly associated with heart defects, which might suggest haemodynamic alterations or genetic causes, even more so in our case with MCDA twins complicated by sFGR. Read More

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Antenatal management and neonatal outcomes of monochorionic twin pregnancies in a tertiary teaching hospital: a 10-year review.

J Obstet Gynaecol 2021 Mar 6:1-11. Epub 2021 Mar 6.

Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium.

Monochorionic (MC) pregnancy is a high risk pregnancy with well-defined specific complications, such as twin-to-twin transfusion syndrome (TTTS) and twin anaemia-polycythaemia sequence (TAPS). Laser photocoagulation (LPC) is an effective treatment for both complications. In the current retrospective study, we determined the incidence of MC pregnancy complications in a tertiary care centre during a 10-year period. Read More

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Loop Ileostomy in Europe's Tiniest Male Newborn for Meconium-Related Ileus.

European J Pediatr Surg Rep 2021 Jan 3;9(1):e17-e19. Epub 2021 Mar 3.

Department of Paediatrics and Adolescent Medicine, Division of Neonatology, Medical University of Graz, Graz, Austria.

With the advances of neonatology, the survival rate for "live-born periviable fetuses" weighing < 300 g, a subgroup of extremely low birth weight (BW) infants, has improved over the past 10 years. Meconium-related ileus (MRI) represents an early postnatal hazard, and, if medical evacuation fails, a surgical challenge in such immature babies. We report the interdisciplinary management of surgically treated MRI in a newborn with a BW of 273 g. Read More

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January 2021

Radiofrequency ablation for selective fetal reduction in complicated Monochorionic twins; comparing the outcomes according to the indications.

BMC Pregnancy Childbirth 2021 Mar 6;21(1):189. Epub 2021 Mar 6.

Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: To evaluate the perinatal outcomes in women with complicated monochorionic diamniotic twins who underwent selective reduction using radiofrequency ablation (RFA).

Methods: This retrospective study included patients with complicated monochorionic diamniotic twins between 16 to 28 weeks who underwent selective reduction using RFA.

Results: During the study period, 143 women with complicated monochorionic twins underwent RFA including 52 with selective fetal growth restriction (sFGR), 48 with twin to twin transfusion syndrome (TTTS), 33 with major fetal anomalies in one of the twins, and 10 with reversed arterial perfusion sequence (TRAP). Read More

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