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Sun J, Sun L, Zhong L. Flexible fetoscope in the treatment of twin-to-twin transfusion syndrome. ANZ J Surg 2021; 91:2499-2502. [PMID: 34582089 DOI: 10.1111/ans.17225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Twin-to-twin transfusion syndrome (TTTS) could be treated with fetoscopic laser photocoagulation. For patients with placenta located on the anterior wall of uterus, surgical procedures are difficult. To solve this problem, a flexible fetoscope was designed in our department. METHODS The flexible fetoscope was made up of polyurethane, fiberglass and stainless steel coils. The specular body was soft and could bend encountering obstacles, which reduced the possibility of injury to the fetus and placenta. The distal tip of the body could curve from -180° to +270° with the control of the handweel. Three pregnant women of TTTS with anterior placenta was operated with this instrument. RESULT All pregnant women were treated smoothly and gave live twins birth at term. Through angiography, it was demonstrated that the vascular connections on the surface had been coagulated. CONCLUSION The flexible fetoscope was a novel instrument in treating TTTS, especially for the anterior placenta.
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Affiliation(s)
- Jie Sun
- Department of Urology, National Children's Medical Center & Shanghai Children's Medical Center, Shanghai, China
| | - Luming Sun
- Department of Obstetrics, Fetal Medicine Unit & Prenatal Diagnosis Center, Shanghai First Maternity and Infant Hospital, Shanghai, China
| | - Liang Zhong
- Department of Urology, National Children's Medical Center & Shanghai Children's Medical Center, Shanghai, China
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Crombag N, Sacco A, Stocks B, De Vloo P, van der Merwe J, Gallagher K, David A, Marlow N, Deprest J. 'We did everything we could'- a qualitative study exploring the acceptability of maternal-fetal surgery for spina bifida to parents. Prenat Diagn 2021; 41:910-921. [PMID: 34228835 PMCID: PMC7613560 DOI: 10.1002/pd.5996] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/05/2021] [Accepted: 06/05/2021] [Indexed: 11/22/2022]
Abstract
Objective To explore the concepts and strategies parents employ when considering maternal-fetal surgery (MFS) as an option for the management of spina bifida (SB) in their fetus, and how this determines the acceptability of the intervention. Methods A two-centre interview study enrolling parents whose fetuses with SB were eligible for MFS. To assess differences in acceptability, parents opting for MFS (n = 24) were interviewed at three different moments in time: prior to the intervention, directly after the intervention and 3-6 months after birth. Parents opting for termination of pregnancy (n = 5) were interviewed only once. Themes were identified and organised in line with the framework of acceptability. Results To parents opting for MFS, the intervention was perceived as an opportunity that needed to be taken. Feelings of parental responsibility drove them to do anything in their power to improve their future child’s situation. Expectations seemed to be realistic yet were driven by hope for the best outcome. None expressed decisional regret at any stage, despite substantial impact and, at times, disappointing outcomes. For the small group of participants, who decided to opt for termination of pregnancy (TOP), MFS was not perceived as an intervention that substantially could improve the quality of their future child’s life. Conclusion Prospective parents opting for MFS were driven by their feelings of parental responsibility. They recognise the fetus as their future child and value information and care focusing on optimising the child’s future health. In the small group of parents opting for TOP, MFS was felt to offer insufficient certainty of substantial improvement in quality of life and the perceived severe impact of SB drove their decision to end the pregnancy.
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Affiliation(s)
- Neeltje Crombag
- Department of Development and Regeneration Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium.,Elizabeth Garrett Anderson Institute of Women's Health, University College London, London, UK
| | - Adalina Sacco
- Elizabeth Garrett Anderson Institute of Women's Health, University College London, London, UK
| | | | - Philippe De Vloo
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Johannes van der Merwe
- Department of Development and Regeneration Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium.,Department of Obstetrics and Gynecology, Division Woman and Child, University Hospitals Leuven, Leuven, Belgium
| | - Katie Gallagher
- Elizabeth Garrett Anderson Institute of Women's Health, University College London, London, UK.,National Institutes for Health, University College London Hospitals Biomedical Research Centre, London, UK
| | - Anna David
- Department of Development and Regeneration Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium.,Elizabeth Garrett Anderson Institute of Women's Health, University College London, London, UK.,National Institutes for Health, University College London Hospitals Biomedical Research Centre, London, UK
| | - Neil Marlow
- Elizabeth Garrett Anderson Institute of Women's Health, University College London, London, UK.,National Institutes for Health, University College London Hospitals Biomedical Research Centre, London, UK
| | - Jan Deprest
- Department of Development and Regeneration Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium.,Elizabeth Garrett Anderson Institute of Women's Health, University College London, London, UK.,Department of Obstetrics and Gynecology, Division Woman and Child, University Hospitals Leuven, Leuven, Belgium
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Mackie FL, Morris RK, Kilby MD. 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; 21:241. [PMID: 33752627 PMCID: PMC7986028 DOI: 10.1186/s12884-021-03687-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/01/2021] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Fiona L. Mackie
- Department of Obstetrics and Gynaecology, Worcestershire Acute NHS Trust, Royal Worcestershire Hospital, Charles Hastings Way, WR5 1DD Worcester, UK
| | - R. Katie Morris
- Institute of Applied Health Research, University of Birmingham, West Midlands Edgbaston, UK
- Fetal Medicine Centre, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham Women’s Hospital, Mindelsohn Way, Edgbaston, UK
| | - Mark D. Kilby
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Women’s and Children’s Health, Birmingham Health Partners, Birmingham, UK
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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; 21:242. [PMID: 33752620 PMCID: PMC7986460 DOI: 10.1186/s12884-021-03688-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/01/2021] [Indexed: 11/10/2022] Open
Abstract
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. entitled "Parental attachment and depressive symptoms in pregnancies complicated by twin-twin transfusion syndrome: a cohort study" to be of high importance and impact, but would like to discuss the extent of its conclusions, and push towards bigger studies in this field.
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