CPT® Code 59072

1. Indications

The procedure of fetal umbilical cord occlusion is indicated under specific circumstances related to monochorionic twin pregnancies. The following conditions warrant this intervention:

• Fetal Anomaly - When one of the monochorionic twins presents with a fetal anomaly that is not consistent with survival, the procedure may be performed to improve the chances of survival for the other twin.
• Fetal Demise - If one twin has suffered a fetal demise, occlusion of the umbilical cord is indicated to sever the vascular link and protect the surviving twin's health.
• Twin-Twin Transfusion Syndrome (TTTS) - This condition, characterized by an abnormal blood exchange between the twins, may necessitate umbilical cord occlusion to address the complications of polyhydramnios and oligohydramnios.

2. Procedure

The procedure of fetal umbilical cord occlusion involves several critical steps, each performed with precision to ensure the safety and effectiveness of the intervention:

• Identification of the Affected Fetus - The physician begins by using continuous ultrasound guidance to locate the umbilical cord of the affected fetus. This step is crucial for determining the appropriate approach for occlusion.
• Accessing the Umbilical Cord - A placental free area is identified to facilitate access to the umbilical cord. This careful selection helps minimize risks during the procedure.
• Introduction of Instruments - A scope is introduced into the uterus, followed by the insertion of small coagulation forceps. These instruments are essential for performing the occlusion effectively.
• Occlusion of the Umbilical Cord - The umbilical cord of the affected fetus is grasped using the coagulation forceps. The physician then occludes the cord using one of several techniques, including laser, suture, or bipolar coagulation. The method chosen depends on the specific circumstances of the case.
• Verification of Occlusion - After the occlusion, color Doppler ultrasound is employed to confirm the successful occlusion of the cord, indicated by the absence of blood flow. This verification is a critical step to ensure the procedure's effectiveness.
• Monitoring and Reporting - Once the procedure is completed, the scope is removed, and the patient is monitored as necessary. The physician discusses the results of the procedure with the patient and prepares a written report detailing the intervention and its outcomes.

3. Post-Procedure

Following the fetal umbilical cord occlusion procedure, the patient is typically monitored for any immediate complications or adverse effects. The physician will assess the patient's condition and may provide specific instructions regarding follow-up care. It is essential for the patient to be informed about the potential outcomes and any signs of complications that may require further medical attention. The physician will also discuss the results of the procedure, including the implications for the surviving twin's health and any necessary next steps in management.