Abstract

Kwok Yin Leung, CP Lee, B Chan, KL Chan, WC Leung, YH Lam, MHY Tang
Department of Obstetrics & Gynaecology, Queen Mary Hospital, Hong Kong

Objective
To review the experience of in-utero intervention in a tertiary referral centre in Hong Kong

Materials and Methods
This was a descriptive study on the prenatal therapeutic procedures performed in Queen Mary Hospital and Tsan Yuk Hospital from 1995 to 2006.

Results
From 1995 to 2006, more than 100 prenatal interventions were performed for various fetal abnormalities.

Sixteen cases of fetal- fetal transfusion syndrome (FFTS) were managed. Before 2003, amnioreduction was the first line therapy. One case of triplet pregnancy complicated by FFTS was successfully treated by serial amnioreduction. However, the overall outcomes after amnioreduction were unsatisfactory. In the recent four years, endoscopic laser therapy has replaced amnioreduction as the first line therapy. We treated six cases of twin-twin transfusion syndrome (TTTS) using endoscopic laser therapy at 19-24 weeks’ gestation. Of these six cases, four were stage III with severely abnormal Doppler in the donor and/or recipient twin, and two were stage IV with hydrops in the recipient twin. In four of these six cases, at least one twin survived and was born healthy without neurological impairment. There were no significant maternal complications.

In one case of monochorionic twin pregnancy, a hydropic fetus was detected at 12 weeks' gestation, and subsequently treated by endoscopic laser cord coagulation. In another case of monochorionic twin pregnancy complicated by severe IUGR at 23 week's gestation, bipolar diathermy coagulation under ultrasound guide was successfully performed. In both cases, a normal co-twin was delivered at term.

In-utero blood transfusion was given in two cases of fetal anemia. In one case of rhesus isoimmunisation, fetal Rhesus genotype was correctly predicted by the examination of maternal plasma DNA. Fetal anemia was predicted by ultrasonographic measurement of the fetal middle cerebral artery peak systolic velocity, confirmed by cordocentesis and successfully corrected by in utero transfusion at 29 weeks and 32 weeks' gestation.

For the percutaneous sonographically guided interventions, chest and bladder tap/shunt was performed for selected cases of pleural effusion and bladder outlet obstruction respectively.

Conclusion
In well-selected cases, fetal abnormalities can be successfully treated by endoscopic and /or sonographically guided fetal intervention.