Successful Closure of Small latrogenic Chorioamniotic Membranes Defect After Fetoscopy with Laser

BACKGROUND: Fetoscopic laser coagulation of the placental anastomoses is the standard treatment for twin -to -twin transfusion syndrome (TTTS). Despite certain improvements in fetoscopic technique, every fourth fetoscopic procedure is still complicated by preterm premature rupture of membranes, leading to ascending infection, fetal demise, and/or preterm delivery. re-TTTS membranes found dystrophic calcification within the treated membranes; this had been covered by amniotic epithelium. occurs after fetoscopy in 2-14% of cases, impairing the outcome. CASE: A 26-year-old woman underwent laser coagulation of placental anastomoses because of stage III TTTS at 21/6 weeks of gestation. A microinvasive fetoscopic technique with 1-mm optic was used. Three weeks later, during a second fetoscopy because of re-TTTS, a defect of the chorioamniotic membranes of about 3 mm(2) in area was visualized. This was without any signs of wound healing. We decided to perform laser coagulation with Nd:YAG laser of 10-30 W energy, moving from the wound's edge to the center until complete closure of the defect could be achieved. The patient gave birth at 34/0 weeks to 2 healthy female infants weighing 2,013 g and 1,712 g. Microscopic evaluation of chorioamniotic membranes found dystrophic calcification within the treated membranes; this had been covered by amniotic epithelium. CONCLUSION: Small iatrogenic amniotic membrane defects could be successfully treated by laser technique.