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Acardiac From: Joshua Copel (Joshua.Copel@QuickMail.Yale.edu) Thu Dec 21 16:14:38 1995 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: by way of gklein@bcm.tmc.edu: "Protocol Format" Previous message: Rudolf Straka: "Re: Vag condyloma and juvenile laryngeal papillomatosis" Subject: Time: 6:03 PM OFFICE MEMO Acardiac Date: 12/21/95 Terry Jones asked about acardiac parasite in one of triplets. We have performed one umbilical cord ligation under ultrasound/endoscopic guidance. It was not easy & I will do the next one with ultrasound alone using a Foley cordostat & some of our office endoscopy equipment. I would leave her alone if the parasite is small. Unless it is compromising one of the other fetuses with high output failure then the risks of any such intervention would, to me, outweigh any benefits. Most of the parasites we have seen in the last few years do not threaten the co-twin. The options with compromise include hysterotomy, & I would leave that to Jim Goldberg & the folks at UCSF if you are in California as they have the biggest experience in the US with hysterotomy in continuing human pregnancies. Next option is endoscopic ligation. Ruben Quintero at Wayne State has done a few of these. We have another approach to offer as noted above. I think the Nicolaides approach (laser of superficial vessels) won't work for this, I even doubt it has much value for Twin-twin transfusion, but that is another discussion. My understanding is that cord injections with thrombogenic materials has not been successful. Josh Copel Yale Ob-Gyn, MFM Joshua.Copel@Yale.edu Next message: by way of gklein@bcm.tmc.edu: "Protocol Format" Previous message: Rudolf Straka: "Re: Vag condyloma and juvenile laryngeal papillomatosis"

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