Long-term immune functions after intrauterine laser treatment for severe twin-twin transfusion syndrome was investigated. Immunologic parameters were measured in 18 twin pairs at a median age of 3.5 years. Both donors and recipients showed no severe deficiencies in total and specific immunoglobulin concentrations.
Objective: Selective intrauterine growth restriction (IUGR) affects up to 25% of all monochorionic twins. Absent end-diastolic velocity of the umbilical artery (AEDV) is present in a subset of these patients. Expectant management in these cases is associated with an increased risk of spontaneous fetal demise of the IUGR twin, with attendant co-morbidity or mortality of the healthy twin. We have previously reported on performing selective laser photocoagulation of communicating vessels (SLPCV) in monochorionic diamniotic twins (MCDA) with selective IUGR. Preliminary data showed no improvement in perinatal survival after SLPCV over expectant management, but did show a tendency for decreased neurological morbidity. We have launched a randomized clinical trial to compare expectant management versus SLPCV in MCDA twins with selective IUGR. Methods: Inclusion criteria: MCDA twins, estimated fetal weight of one of the twins < 10th percentile with AEDV, normal karyotype, absence of major congenital anomalies, no evidence of twin-twin transfusion syndrome (maximum vertical pockets (MVP) = > 8 cm < 2 cm, combined), gestational age 16-26 weeks, no sonographic evidence of neurological damage. Criteria for qualification as a laser center: experience with laser treatment of twin-twin transfusion syndrome with ability to treat anterior placentas percutaneously and > 75% survival of at least one twin. Primary outcome will be neurological morbidity at one month of age. Secondary outcome will include perinatal survival of at least one twin.Results: Approximately fifty-eight patients will be required in each arm to demonstrate a difference of 20% with a power of 80% in terms of neurological morbidity.
Conclusions:The study is ongoing. All experienced laser centers and interested colleagues and institutions are welcome to participate. Objective: To investigate long-term neurodevelopmental outcome, cardiac morphology and function and renal function in survivors of severe mid-trimester twin-twin transfusion syndrome after fetoscopic laser coagulation of placental anastomoses. Methods: 167 infants underwent a standardized physical and neurological examination and a developmental test at a median age of 3 years and 2 months. In 89 survivors, a detailed echocardiography and assessment of systolic and diastolic cardiac function was performed at a median age of 1 year and 9 months. Serum and urine concentrations of various laboratory parameters reflecting kidney function were measured in 18 surviving twin pairs at a median age of 3 years and 1 month. Results: 145 (87%) infants showed normal development, 12 (7%) showed minor and 10 (6%) major neurological abnormalities. 4/51 (8%) former recipients had pulmonary stenosis and 2 of them required balloon-dilatation. Moderate and small atrial septal defects were found in 5/89 (6%) survivors. All laboratory findings were within normal ranges and there were no differences between former donors and recipients. Conclusions: Intrauterine laser coagulation seems to be the most effective treatment opt...
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