Laser coagulation in complicated monochorionic pregnancies
Author
Peeva, GerganaEntity
UAM. Departamento de Obstetricia y GinecologíaDate
2018-05-23Subjects
Embarazo múltiple - Complicaciones y secuelas - Tesis doctorales; MedicinaNote
Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Obstetricia y Ginecología. Fecha de lectura: 23-05-2018Esta obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial-SinObraDerivada 4.0 Internacional.
Abstract
Monochorionic pregnancies are found in 1 in 200 births, but the incidence is
increasing because of the widespread use of assisted reproductive technology.
Monochorionic twins, compared to dichorionic twins, have a considerably higher
risk of pregnancy complications that are dues to the process of splitting of the
single embryonic mass [congenital abnormalities, conjoint twins, selective fetal
growth restriction (sFGR)] and the communicating placental vessels between
the two circulations [twin-to-twin transfusion syndrome (TTTS), twin reversed
arterial perfusion (TRAP) sequence, twin anemia polycythemia sequence
(TAPS)].
This thesis reports on the outcome of pregnancies with sFGR (with and without
superimposed TTTS) treated by endoscopic laser separation of the inter-twin
communicating placental vessels.
Triplet pregnancies in which two or all three fetuses are monochorionic, are at
very high risk of perinatal death. The incidence of dichorionic triamniotic
pregnancies has dramatically increased following the practice of IVF with
delayed transfer of two embryos.
This thesis reports on the outcome of monochorionic and dichorionic triplet
pregnancies complicated by TTTS (with and without sFGR) treated by
endoscopic laser separation of the communicating placental vessels. The
thesis also reports on the development of a first-trimester technique for embryo
reduction of one of the two monochorionic twins by ultrasound-guided interstitial
laser ablation of the pelvic vessels
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