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 Cord Coagulation
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What is Cord Coagulation?

Cord coagulation is a procedure used in twin pregnancies with a shared placenta (monochorionic) to selectively terminate one twin. It is a minimally invasive procedure, in which a needle is guided by ultrasound into the umbilical cord and the blood flow is coagulated either by radiofrquency ablation or bipolar cautery.   This interrupts the blood communication between the fetuses, and allows the remaining twin to progress as a singleton,without the complications from a sponatenous death.  The demised baby remains in the amniotic cavity and to a certain degree, will begin to be reabsored. 

While this is a difficult decision for families, it can be the right decision for some as it maximizes the optimal outcome for the surviving twin by eliminating the risk of death or brain damage from a spontaneous demise.

How is it done?
 
Cord coagulation can be accomplished either by bipolar forceps or radiofrequency ablation.  The technique depends on the particular case, and whichever is deemed to be the safest and easiest for that situation.
 
Bipolar cautery is performed in the operating room under spinal anesthesia. A tiny incision is made in the skin so that a very small camera (fetoscope) can be inserted into the uterus.  Through this camera, a bipolar forceps is guided to the umbilical cord of the affected twin.  The cord is clamped to stop the blood from flowing to this twin.  This surgery is performed takes approximately 30-60 minutes.  
 
RadioFrequency ablation is done under local anesthesia (lidocaine) in the Maternal Fetal Medicine office.  A small needle is guided to the umbilical cord of the affected twin via ultrasound.  The umbilical cord is heated so that the blood vessels in the cord are simultaneously sealed.  This procedure takes approximately 15 minutes.
 
Who is suitable for Cord Coagulation?
 
Monochorionic twin pregnancies with one or more of the following situations:
  • Severe Twin to Twin Transfusion Syndrome
  • Twin Reversed Arterial Perfusion (TRAP) Sequence
  • Severe discordant anomalies
  • Severe Selective Intrauterine Growth Restriction (SIUGR)
What is cord transection?
 
In monoamniotic twins, where twins share a placenta as well as an amniotic sac, there is concern about umbilical cord entanglement, which could result in fetal demise.  Cord coagulation may make the risk of entanglement higher, so it is recommended that the umbilical cord is also transected, or cut in these cases.   In this situation, a cord coagulation would be performed first with bipolar cautery-- clamping the cord in two locations in close proximity.  Tiny scissors would be guided with ultrasound to transect the cord between the two coagulated sites.  

 

What is Cord Coagulation?

Cord coagulation is a procedure used in twin pregnancies with a shared placenta (monochorionic) to selectively terminate one twin. It is a minimally invasive procedure, in which a needle is guided by ultrasound into the umbilical cord and the blood flow is coagulated either by radiofrquency ablation or bipolar cautery.   This interrupts the blood communication between the fetuses, and allows the remaining twin to progress as a singleton,without the complications from a sponatenous death.  The demised baby remains in the amniotic cavity and to a certain degree, will begin to be reabsored. 

While this is a difficult decision for families, it can be the right decision for some as it maximizes the optimal outcome for the surviving twin by eliminating the risk of death or brain damage from a spontaneous demise.

How is it done?
 
Cord coagulation can be accomplished either by bipolar forceps or radiofrequency ablation.  The technique depends on the particular case, and whichever is deemed to be the safest and easiest for that situation.
 
Bipolar cautery is performed in the operating room under spinal anesthesia. A tiny incision is made in the skin so that a very small camera (fetoscope) can be inserted into the uterus.  Through this camera, a bipolar forceps is guided to the umbilical cord of the affected twin.  The cord is clamped to stop the blood from flowing to this twin.  This surgery is performed takes approximately 30-60 minutes.  
 
RadioFrequency ablation is done under local anesthesia (lidocaine) in the Maternal Fetal Medicine office.  A small needle is guided to the umbilical cord of the affected twin via ultrasound.  The umbilical cord is heated so that the blood vessels in the cord are simultaneously sealed.  This procedure takes approximately 15 minutes.
 
Who is suitable for Cord Coagulation?
 
Monochorionic twin pregnancies with one or more of the following situations:
  • Severe Twin to Twin Transfusion Syndrome
  • Twin Reversed Arterial Perfusion (TRAP) Sequence
  • Severe discordant anomalies
  • Severe Selective Intrauterine Growth Restriction (SIUGR)
What is cord transection?
 
In monoamniotic twins, where twins share a placenta as well as an amniotic sac, there is concern about umbilical cord entanglement, which could result in fetal demise.  Cord coagulation may make the risk of entanglement higher, so it is recommended that the umbilical cord is also transected, or cut in these cases.   In this situation, a cord coagulation would be performed first with bipolar cautery-- clamping the cord in two locations in close proximity.  Tiny scissors would be guided with ultrasound to transect the cord between the two coagulated sites.  

 

Laser Photocoagulation | Alternative Treatments for TTTS | RadioFrequency Ablation (RFA) | Cord Coagulation/Transection
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