Experience with fetoscopic cord ligation

Objective. In the case of a monochorionic multiple pregnancy with one non-viable fetus who compromises its co-twin, fetoscopic cord ligation may be performed. We describe our fetoscopic cord ligation technique and discuss the efficacy of cord ligation for salvaging the co-twin, based on available data. Study design. Descriptive case series of four cases and review of the cases published up to 1996. Results. We performed four successful ligations. Of the 23 reported cases, which include the present series, two ligations failed. Four fetuses died in utero, and 17 were born alive at a mean of 8 weeks following the procedure. Two babies died in the perinatal period, a third after 60 days. Preterm uterine contractions do not seem to be a clinical problem. Preterm prelabour rupture of the membranes (PPROM) complicates about 40% of cases, the majority occurring prior to 32 weeks. Conclusion. Fetoscopic cord ligation is a feasible procedure with a 71% survival rate and a high risk for PPROM. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.