Selective Fetoscopic Laser Photocoagulation of Superficial Placental Anastomoses for the Treatment of Severe Twin-Twin Transfusion Syndrome

Abstract

OBJECTIVE: To report our initial institutional experience with fetoscopic laser photocoagulation of placental anastomoses in severe twin-twin transfusion syndrome using a 1.0 mm endoscope. METHODS: Between July 2006 and June 2008, 19 monochorionic diamniotic twin pregnancies complicated by severe TTTS (Quintero stages III and IV) underwent fetoscopic laser therapy. Perinatal data were prospectively collected and compared according to the Quintero stages. RESULTS: Nine patients were classified as stage III and ten as stage IV. The Mean gestational ages at diagnosis and procedure were 20 (range: 17-25) and 22.0 (range: 19.0-26.0) weeks, respectively, with no statistical difference between the two groups. Preterm premature rupture of the membranes occurred in two cases (10.5%), and spontaneous preterm delivery in eight (42.1%). Overall mean gestational age at delivery was 32.1 (range: 26.0-38.0) weeks. Prematurity was more severe in stage IV patients (p<0.01). Among all cases, the overall survival rate was 52.6%, and the percentages of pregnancies with survival of both babies and at least one twin were 26.3% and 78.9%, respectively. In the case of stage III patients, the overall survival rate was 61.1%. Of the stage III pregnancies, 33.3% resulted in both babies surviving, and 88.9% of these pregnancies resulted in at least one surviving twin. For stage IV, as the corresponding statistics were 45.0%, 20.0% and 70.0% respectively. CONCLUSIONS: Our initial institutional experience with 1.0 mm fetoscopic laser therapy for severe TTTS showed results similar to those reported in the literature for larger endoscopes

Stage-Related Outcome after Fetoscopic Laser Ablation in Twin-to-Twin Transfusion Syndrome

“…By contrast, Ruano et al [11] reported a similar survival rate at 52.6% in both donor and recipient twins. Similarly, in the study of Taylor et al [15] the difference between survival rates of donor and recipient twins did not reach significance.…”

“…Apart from these studies performed in experienced centers, there are a few reports from developing countries (table 2). Ruano et al [11] reported an overall survival rate of 52.6% with at least one survivor in 78.9% of cases in Brazil. The corresponding rates were 51.5 and 75.8% in Chile [10] and 60 and 77% in Mexico [12].…”

“…Similarly, Ruano at al. [11] reported a tendency for increased perinatal survival for stage III TTTS as compared with stage IV cases, but the difference did not reach statistical significance. Huber et al [7] also reported a significant trend toward reduced survival rate of at least one twin and both fetuses with increasing stage.…”

“…Furthermore, the vast majority of the reports about TTTS outcome after laser therapy came from highly experienced centers in the USA and Europe. The outcome data in the other regions of the world are scarce with only a few studies in the literature [10,11,12]. …”

Twenty-Five Years of Fetoscopic Laser Coagulation in Twin-Twin Transfusion Syndrome: A Systematic Review

“…After full-text analysis a total of 34 studies were included in the time-based analysis [10,12,13,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48]. Twelve studies [5,49,50,51,52,53,54,55,56,57,58,59] presented data overlapping other series, of which one presented data relevant for the technique-based analysis [58].…”