Complicated monochorionic twin pregnancies: Experience with bipolar cord coagulation

OBJECTIVE: The purpose of the study was to evaluate our experience with ult rasound-guided bipolar diathermy forceps for cord occlusion in complicated monochorionic twin pregnancies. STUDY DESIGN: Seventeen consecutive cases were included: 9 cases were twin- to-twin transfusion syndrome; 2 cases were twin reversed arterial perfusion syndrome, and 6 cases were discordant for fetal abnormality. Bipolar diath ermy was performed under local anesthetic with the use of 3-mm forceps with ultrasound guidance. RESULTS. Cord occlusion was successfully accomplished in all cases between 18 and 27 weeks' gestation. There were 2 deaths of the co-twin within 12 ho urs; 1 death was due to cord hemorrhage, and 1 death was unexplained. One n eonatal death occurred after delivery at 27 weeks, and 1 woman with twin-to -twin transfusion syndrome elected termination of pregnancy when hydrocepha ly was diagnosed 7 days after the procedure (probably related to the underl ying pathologic condition). All other co-twins are alive and well, although 2 pregnancies were complicated by preterm delivery and premature rupture o f membranes before 30 weeks' gestation. CONCLUSION: Bipolar diathermy is an effective procedure for cord occlusion, although it still has significant morbidity and mortality rates.