FLP in pregnancy most commonly refers to Fetoscopic Laser Photocoagulation, a surgical procedure used to treat complications in twin or higher-order multiple pregnancies.
Here's a more detailed explanation:
Fetoscopic Laser Photocoagulation (FLP): A Detailed Overview
Fetoscopic Laser Photocoagulation (FLP) is a minimally invasive surgical procedure performed during pregnancy to treat specific complications arising in multiple pregnancies, primarily those involving shared placentas. The most common conditions addressed by FLP are:
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Twin-Twin Transfusion Syndrome (TTTS): This is the primary indication for FLP. TTTS occurs when abnormal blood vessel connections develop in the shared placenta of monochorionic twins (twins sharing a placenta). These connections allow blood to flow disproportionately from one twin (the donor) to the other (the recipient). This can lead to severe complications for both twins, including heart failure in the recipient and dehydration in the donor.
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Selective Intrauterine Growth Restriction (sIUGR): This condition occurs when one twin in a monochorionic pregnancy grows significantly slower than the other. This can happen due to unequal sharing of the placenta and can lead to serious health problems for the smaller twin. FLP might be considered in sIUGR cases, especially when accompanied by abnormal Doppler findings indicating poor blood flow to the smaller twin and oligohydramnios (low amniotic fluid).
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Feto-Fetal Transfusion Syndrome in Triplets: While less common, FLP can also be used as a treatment option for this syndrome in triplet pregnancies.
How FLP Works
The procedure involves inserting a small camera (fetoscope) into the uterus through a small incision in the mother's abdomen. Using the fetoscope, the surgeon identifies the abnormal blood vessel connections on the surface of the placenta. A laser fiber is then used to carefully cauterize (seal) these vessels, effectively separating the circulatory systems of the twins.
When is FLP Considered?
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TTTS: FLP is typically considered for TTTS when the condition is progressing despite other management strategies, such as amnioreduction (removing excess amniotic fluid from the recipient twin's sac).
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sIUGR: FLP is generally considered for sIUGR only when there are significant complications, like abnormal Doppler studies indicating compromised blood flow, and oligohydramnios around the growth-restricted twin. The decision is based on careful assessment of the potential risks and benefits for both twins. It's considered a potential benefit specifically if oligohydramnios is present.
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Gestational Age: FLP is most commonly performed between 16 and 26 weeks of gestation. While the reference indicates it can be a treatment option for TTTS after 26 weeks, this is less common.
Important Considerations
FLP is a complex procedure with potential risks for both the mother and the babies. It's crucial to have a thorough evaluation by a specialist experienced in performing FLP to determine if it's the appropriate treatment option.
