A Simpler Technique for Umbilical-Cord Blockade of an Acardiac Twin

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Abstract
The method reported by Quintero et al. (Feb. 17 issue)1 of umbilical-cord ligation of an acardiac twin by fetoscopy is clearly superior to hysterotomy2 and to ultrasound-guided procedures reported so far. The intraarterial placement of coils has been associated with recanalization of the umbilical cord, and the injection of fibrin or glue material has resulted in the death of both twins, most likely because of intravascular transfer of the material through vascular anastomoses in the monozygotic placentas. We have developed a simpler technique for in utero management of twins with reversed-arterial-perfusion sequence. This approach uses a much thinner needle, with no need for an additional optical canal, grasper, external knot-pushing, and the like.

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