Post fetoscopy laser therapy in twins

case report

Abstract

OBJECTIVES: Introduction: Monochorionic twin gems are related to increased morbidity and mortality. One of the main causes of increase in these rates is fetofetal transfusion syndrome, the unequal sharing of blood flow between movements through vascular anastomosis present in the single placenta. Mortality of the syndrome reaches 90% when there is no adequate treatment. The aim of this paper is to present a case of post-fetoscopic twin laser therapy in a high-risk pregnancy. CASE DESCRIPTION: L.E.L.C, 30 years old, G2P2, underwent laser therapy fetoscopy in gestation of monorionic and diamniotic twins at 19 weeks, diagnosed with Fetal Transfer Syndrome. In a USG performed on 10/04/2018, with a 16-week and 5-day ultrasound gestational age, the fetus had a bladder diameter of 0.69 cm, while fetus II was 0.98 cm in diameter, being the same ultrasound, observed an increase in amniotic fluid level II and decreased in amniotic fluid level I. Day 20/10/2018 was performed or the procedure of laser therapy with fetoscopy, being totally successful and allowed normal use of both fetuses until the end of pregnancy. DIAGNOSIS AND DISCUSSION: Diagnosis of the syndrome is more common in the second trimester of pregnancy and requires ultrasound filling: an identification of monorionic / diamniotic pregnancy compatible with the presence of the largest vertical support (MBV) of an amniotic less than or equal to 2.0. cm on one side and MBV greater than or equal to 8.0 cm on the other. In the therapeutic approach of the syndrome, Laser Coagulation Fetoscopy is currently considered the first line treatment for this syndrome between 16 and 26 weeks. The major goal of treatment is to promote or block the causative connections of the fetofetal syndrome while maintaining the maximum preserved functional territory. CONSIDERATIONS: Monorionic twin management is of high risk and its management requires constant attention. Intrauterine interventions require experience and a high degree of attention and are very resolute.