There are several techniques to perform the cord occlusion procedure and we will choose the most appropriate one depending on your presentation. You will be admitted to hospital and appropriate preoperative preparations and consults will be completed. You will not have anything to eat or drink on the day of the procedure. The detailed consent form will be reviewed with you. For most patients, the procedure is performed in the Operating room on the Labor and Delivery Suite. After you are positioned comfortably on the examination table, ultrasound will used to identify the best place to enter the uterine cavity. When this is done you will receive a local anesthetic in this area, which will be prepared in sterile fashion. . In addition you will receive an infusion with magnesium sulfate to decrease the likelihood of preterm labor. A needle will the be inserted into the uterine cavity under ultrasound guidance. The instrument used to perform the cord occlusion will be guided to the selected umbilical cord. The cord is then occluded using electrical, or laser energy. The procedure itself lasts 10-20 minutes.
Following the procedure you may need to spend one night in the hospital depending on procedure details. We plan two mandatory follow-up ultrasound examinations at the Center for Advanced Fetal care at strategic intervals. If this is prohibitive due to distance, we will provide telemedicine consultation with your referring obstetrician or perinatologist. Ongoing prenatal care and delivery planning is usually continued with your referring obstetrician, but we are immediately available throughout your pregnancy, for any issues that arise. We will obtain your permission to receive data on the delivery of your baby. This follow up is extremely important to us - it is one pf the most important aspects of our experience with this condition. Ultimately other families will also benefit from this experience.
You will be admitted to the hospital and appropriate preoperative preparations and consults will be completed. You will not have anything to eat or drink on the day of the procedure. The detailed consent form will be reviewed with you.. You will be positioned comfortably on an examination table for the duration of the procedure. An experienced senior perinatologist will be present during the procedure and at least one of the operators will be one who has had training in fetal surgery as well as Laser-therapy at participating centers of the Eurofetus project.
The procedure is performed under local anesthesia and you may receive additional pain medications intravenously (conscious sedation). Alternatively, you may receive the same type of epidural anesthesia that is given in labor. In preparation for the procedure you will receive Indomethacin prior to the procedure. On the day of the procedure you will also be started on intravenous Magnesium. Both of these medications are given to decrease the risk of preterm labor. You will also receive an antibiotic on the day of the procedure to decrease the risk of infection.
After all preparations have been completed an ultrasound examination will be performed to determine the ideal access site for the insertion of the fetoscope and the laser fiber. The skin will be sterilized over this area of the abdomen, then the local anesthetic ("numbing medicine") will be applied and a small incision of the skin will be made. Through this incision a needle will be directed into the uterine cavity. This will be done under ultrasound guidance to avoid the placenta and fetuses. Through this needle the fetoscope (2 mm wide) is introduced. Now the connecting vessels on the surface of the placenta will be identified. The KTP laser fiber will be inserted. The connecting vessels are coagulated under direct vision using the Laser until blood flow ceases. The procedure lasts between 30-60 minutes. At the end of the procedure the excess amniotic fluid is drained. This amniodrainage is safe for the twins, because the vascular anastomoses are now all sealed shut - there are no more connections, provided we have been able to complete the procedure. The amniotic fluid from the sac of the recipient can be used for analysis of the chromosomes of that baby.
The complication of preterm delivery may occur despite the procedure or it may even be triggered by the procedure resulting in preterm delivery or stillbirth. There is no guarantee that the treatment will result in good outcome for the babies. The procedure may be technically difficult in cases where the placenta is in front, or if vessels cannot be visualized completely. Bleeding into the amniotic sac from the insertion site of the trochar or the placental vessels can lead to impairment of visualization, and may mean that the procedure must be abandoned before it is completed.
Following the procedure you may need to spend one or more nights in the hospital depending on procedure details. We plan at least two mandatory follow-up ultrasound examinations at the Center for Advanced Fetal care at strategic intervals. This is critical to assess completeness of the procedure and responses of your babies to the treatment. If later postoperative travel is prohibitive due to distance, we will provide telemedicine consultation with your referring obstetrician or perinatologist. Ongoing prenatal care and delivery planning is usually continued with your referring obstetrician, but we are immediately available throughout your pregnancy, for any issues that arise. We will obtain your permission to receive data on the delivery of your baby. This follow up is extremely important to us - it is one pf the most important aspects of our experience with this condition. Ultimately other families will also benefit from this experience.
