April 5th, 2020

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Successful Closure of Small Iatrogenic Chorioamniotic Membranes Defect After Fetoscopy with Laser: A Case Report
Authors:  Michael Tchirikov, M.D., Ph.D., Jörg Buchmann, M.D., Ph.D., and Michael Bergner, M.D.
BACKGROUND: Fetoscopic laser coagulation of the placental anastomoses is the standard treatment for twin-to-twin transfusion syndrome (TTTS). Despite certain improvements in fetoscopic technique, every fourth fetoscopic procedure is still complicated by preterm premature rupture of membranes, leading to ascending infection, fetal demise, and/or preterm delivery. re-TTTS occurs after fetoscopy in 2–14% of cases, impairing the outcome.

CASE: A 26-year-old woman underwent laser coagulation of placental anastomoses because of stage III TTTS at 21/6 weeks of gestation. A microinvasive fetoscopic technique with 1-mm optic was used. Three weeks later, during a second fetoscopy because of re-TTTS, a defect of the chorioamniotic membranes of about 3 mm2 in area was visualized. This was without any signs of wound healing. We decided to perform laser coagulation with Nd:YAG laser of 10–30 W energy, moving from the wound’s edge to the center until complete closure of the defect could be achieved. The patient gave birth at 34/0 weeks to 2 healthy female infants weighing 2,013 g and 1,712 g. Microscopic evaluation of chorioamniotic membranes found dystrophic calcification within the treated membranes; this had been covered by amniotic epithelium.

CONCLUSION: Small iatrogenic amniotic membrane defects could be successfully treated by laser technique.
Keywords:  amniotic membrane, chorioamniotic membranes, fetofetal transfusion, fetoscopy, laser, PPROM, TTTS, twin-to-twin transfusion syndrome, twin twin transfusion syndrome
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