Abstract：
BACKGROUND: Twin reversed arterial perfusion sequence is a rare complication of monochorionic multifetal pregnancies. In this syndrome, the acardiac twin has a nonfunctional heart, while the other twin, the pump twin, has normal development. The pump twin perfuses the acardiac twin and is therefore at risk for cardiac decompensation. In monoamniotic cases, the normal co-twin is also at risk of sudden death due to cord entanglement. Treatment consists of coagulation and transection of the acardiac\'s umbilical cord. We report the first intrauterine use in pregnancy of a Ho:yttrium aluminum garnet laser to safely and successfully transect the umbilical cord after Nd:yttrium aluminum garnet coagulation.
METHODS: A 30-year-old Caucasian woman was referred to our fetal-maternal medicine unit at 9 weeks gestation with a monochorionic-monoamniotic twin pregnancy complicated by an acardiac twin. After counseling, she opted for an elective intervention to minimize the risks to the pump twin. At 16 weeks, fetoscopy was performed using a single 2-mm entry port. Through this port, a 1.0-mm fetoscope and a 0.365-mm laser fiber were introduced. Under fetoscopic sight and ultrasound (Doppler) guidance, the umbilical cord of the acardiac twin was first coagulated by laser energy using a Nd:yttrium aluminum garnet laser and then, using the same fiber, transected using a Ho:yttrium aluminum garnet laser. The patient underwent cesarean section at 38 weeks and delivered a healthy baby.
CONCLUSIONS: We present the first report on intrauterine use of an Ho:yttrium aluminum garnet laser in human pregnancy. Ho:yttrium aluminum garnet laser energy can be successfully and safely used for umbilical cord transection and carries fewer risks than other methods of transection.
METHODS: A 30-year-old Caucasian woman was referred to our fetal-maternal medicine unit at 9 weeks gestation with a monochorionic-monoamniotic twin pregnancy complicated by an acardiac twin. After counseling, she opted for an elective intervention to minimize the risks to the pump twin. At 16 weeks, fetoscopy was performed using a single 2-mm entry port. Through this port, a 1.0-mm fetoscope and a 0.365-mm laser fiber were introduced. Under fetoscopic sight and ultrasound (Doppler) guidance, the umbilical cord of the acardiac twin was first coagulated by laser energy using a Nd:yttrium aluminum garnet laser and then, using the same fiber, transected using a Ho:yttrium aluminum garnet laser. The patient underwent cesarean section at 38 weeks and delivered a healthy baby.
CONCLUSIONS: We present the first report on intrauterine use of an Ho:yttrium aluminum garnet laser in human pregnancy. Ho:yttrium aluminum garnet laser energy can be successfully and safely used for umbilical cord transection and carries fewer risks than other methods of transection.
摘要：
背景：双动脉反向灌注序列是单绒毛膜多胎妊娠的罕见并发症。在这种综合症中，无心双胞胎的心脏没有功能,而另一个双胞胎,双泵，有正常发展。泵双胞胎灌注无心双胞胎，因此有心脏代偿失调的风险。在单羊膜病病例中，正常的双胞胎也有因脐带缠结而猝死的风险。治疗包括凝血和切断无心脐带。我们报告了首次在宫内使用Ho：钇铝石榴石激光在Nd：钇铝石榴石凝固后安全成功地横断脐带。
方法：一名30岁的白种人妇女在妊娠9周时被转诊到我们的胎儿-母体医学单元，患有单绒毛膜-单羊膜双胎妊娠并伴有无心双胎。经过咨询,她选择了选择性干预措施，以最大程度地降低双胎泵的风险。16周时,使用单个2毫米入口进行胎儿镜检查。通过这个港口,介绍了1.0毫米的胎儿镜和0.365毫米的激光光纤。在胎儿镜和超声（多普勒）引导下，首先使用Nd：钇铝石榴石激光通过激光能量使无心双胞胎的脐带凝固，然后，使用相同的纤维，使用Ho：钇铝石榴石激光器进行横切。患者在38周时进行了剖宫产，并分娩了健康的婴儿。
结论：我们首次报道了人妊娠宫内使用Ho:钇铝石榴石激光。Ho：钇铝石榴石激光能量可以成功安全地用于脐带横断，并且比其他横断方法风险更小。
方法：一名30岁的白种人妇女在妊娠9周时被转诊到我们的胎儿-母体医学单元，患有单绒毛膜-单羊膜双胎妊娠并伴有无心双胎。经过咨询,她选择了选择性干预措施，以最大程度地降低双胎泵的风险。16周时,使用单个2毫米入口进行胎儿镜检查。通过这个港口,介绍了1.0毫米的胎儿镜和0.365毫米的激光光纤。在胎儿镜和超声（多普勒）引导下，首先使用Nd：钇铝石榴石激光通过激光能量使无心双胞胎的脐带凝固，然后，使用相同的纤维，使用Ho：钇铝石榴石激光器进行横切。患者在38周时进行了剖宫产，并分娩了健康的婴儿。
结论：我们首次报道了人妊娠宫内使用Ho:钇铝石榴石激光。Ho：钇铝石榴石激光能量可以成功安全地用于脐带横断，并且比其他横断方法风险更小。
