*SPECIAL GUEST* - Dr. Saul Snowise – Part 1 of 2

This week we continue our discussion with Dr. Saul Snowise talking about the role of selective reduction, specifically in the setting of monochorionic twins. This week we'll be covering the following: 

• Dr. Snowise’s preferred tool/method for selective reduction
• Selective reduction in the setting of monoamniotic twins with discordant anomalies & cord entanglement
• Various instruments & equipment used for the different methods of selective reduction
  • How instrument/trocar size affects complication rates
• Discordant anomalies in monochorionic/identical twins
• Twin reversed arterial perfusion (TRAP) sequence
  • Rate of occurrence
  • Pathophysiology/disease process
  • Optimal timing for fetal intervention/surgery
• Selective reduction for sIUGR
  • Patient counseling and informed consent
  • Laser ablation as treatment for sIUGR
• Effects of legislation and the overturning of Roe v. Wade on selective reduction as a treatment option in pregnancy

*SPECIAL GUEST* - Dr. Saul Snowise – Part 1 of 2

This week and next week we have a two-part series with Dr. Saul Snowise as we discuss the role of selective reduction, specifically in the setting of monochorionic twins. Join us as we discuss the following this week:

• How selective reduction differs in monochorionic vs. dichorionic twins 
  • Most common method of selective reduction
    • Potassium chloride (KCl) injection contraindicated in monochorionic twins  
  • Method for monochorionic pregnancy
    • Cord occlusion
• Indications for selective reduction in monochorionic twins
  • Selective fetal growth restriction (sIUGR)
  • Discordant anomalies
  • Twin-twin transfusion syndrome (TTTS)
  • Twin reverse arterial perfusion (TRAP) sequence
  • Failed laser
• Various methods for performing a cord occlusion selective reduction
  • Microwave
  • Interstitial laser
  • Radiofrequency ablation (RFA)
  • Bipolar cautery
• Sizes of operative instruments, energy levels used and the treatment protocols
• Gestational age thresholds for performing a selective reduction procedure
• Risks associated with a selective reduction procedure
  • Membrane complications (i.e. PPROM)
  • Preterm delivery
  • Bleeding, infection 
  • Loss of co-twin
• Pre-operative counseling with patients
• Follow-up and surveillance for the remainder of the pregnancy

Tune in next week for part 2!

Welcome back "What they didn't teach you in laser school" – now onto Part 2! This week we’re going to continue talking about all our laser tips & tricks while discussing the following:  

• Anterior placenta challenges
  • Future of steerable operative scopes
    • Current 30 degree operative Storz scope
  • Using external pressure to aid in flattening the uterus
  • Intraoperative amnioinfusion
• Intraoperative complications
  • Concurrent fetal bradycardia in both fetuses
  • What to do when the laser won’t stop firing
  • Intra-operative bleeding
• Post-operative complications
  • Bleeding
    • Placental abruption
    • Intraperitoneal bleeding
  • Amniotic fluid leakage
    • PROM (premature rupture of membranes)
    • Intraperitoneal amniotic fluid leakage