Fetal therapy in twin reserve arterial perfusion sequence pregnancies with alcohol ablation or bipolar cord coagulation

Abstract
Objective We aimed to evaluate perinatal outcome of seven pregnancies with twin reserve arterial perfusion sequence.



Materials and methods Study group included seven cases of acardiac twins. Out of seven acardiac twins, two cases were followed without interventions.
We performed four alcohol ablation and one bipolar caogulation. For alcohol ablation, a 20-gauge needle guided with color
Doppler USG was directed to abdominal insertion site of the single umbilical artery of the acardiac twin, and 1.0–2.0 mL of
absolute alcohol was injected. For bipolar coagulation of the umbilical cord, we used 3.5 mm laparoscopic trocar and 3.0 mm
bipolar forceps. The procedures were performed under the guidance of transabdominal ultrasonography.



Results Gestational age of the cases at diagnosis and at delivery was 15–32 and 17–38 weeks, respectively. Two cases without intervention
were lost at 17 and 32 weeks. The mean time of procedure for bipolar coagulation and alcohol ablation were 30 and 10 min,
respectively. One of the four cases of alcohol ablation group was aborted although alcohol ablation was succesful. Another
one case was aborted after alcohol ablation due to lost of fetal cardiac activity of the pump fetus. In two other cases, umbilical
cord ablation with alcohol was successful, and they delivered live birth at 36 and 38 weeks. In one case, we performed bipolar
cord coagulation successfully, and the case delivered live birth at 39 weeks. The overall survival rate for intrauterine surgery
was 60% (N 3/5).



Conclusion In twin reserve arterial perfusion sequence pregnancies with findings of poor prognosis, alcohol ablation or bipolar cord
coagulation as fetal therapy under the guidance of ultrasonography can be done successfully, and should be offered as a choice
to families upon discussion of intervention or follow-up with own complications.



Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00404-008-0746-9Authors
Ahmet Gul, Women and Children Hospital Maternal and Fetal Unit, Department of Obstetrics and Gynecology, Istanbul Bakirkoy Istanbul TurkeyKemal Gungorduk, Women and Children Hospital Maternal and Fetal Unit, Department of Obstetrics and Gynecology, Istanbul Bakirkoy Istanbul TurkeyGokhan Yildirim, Women and Children Hospital Maternal and Fetal Unit, Department of Obstetrics and Gynecology, Istanbul Bakirkoy Istanbul TurkeyAli Gedikbasi, Women and Children Hospital Maternal and Fetal Unit, Department of Obstetrics and Gynecology, Istanbul Bakirkoy Istanbul TurkeyDogukan Yildirim, Women and Children Hospital Maternal and Fetal Unit, Department of Obstetrics and Gynecology, Istanbul Bakirkoy Istanbul TurkeyYavuz Ceylan, Women and Children Hospital Maternal and Fetal Unit, Department of Obstetrics and Gynecology, Istanbul Bakirkoy Istanbul Turkey