Fetoscopic laser ablation of placental vessels in severe previable twin-twin transfusion syndrome

A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome

“…Survival with this approach is reported to be 53 to 56% [17][18] , comparable to survival rates observed with AR. An intriguing finding which stimulated interest in this approach was the observation that newborn survivors treated by fetoscopic laser appeared to have a lower incidence of head ultrasound or MRI abnormalities (5-7% vs. 14-25%) 5,[17][18][19][20] .…”

“…Numerous treatment options for TTTS have been reported, including amnioreduction (AR) [6][7][8][9][10][11][12] , intertwin septostomy [13][14][15][16] , non-selective fetoscopic laser [17][18][19][20] selective fetoscopic laser photocoagulation (SFLP) [21][22][23][24][25][26][27][28] , and cord coagulation [29][30][31][32] , all of which have improved survival rates compared to the untreated natural history of TTTS. It has been controversial which of these treatment options would provide the best outcome in specific cases of TTTS.…”

“…Fetoscopic laser photocoagulation for TTTS was first described by De Lia et al, as a means of functionally converting a monochorionic placenta to a dichorionic one by occluding vascular connections between the twins normally present in monochorionic placentas 17,18 . While these vascular connections are not the cause of TTTS, they are a necessary prerequisite for the syndrome.…”

“…While these vascular connections are not the cause of TTTS, they are a necessary prerequisite for the syndrome. This technique as originally described, and still in use in some centers, is nonselective in nature, meaning all vessels found to cross the intertwin membrane were photocoagulated 17,18 . Survival with this approach is reported to be 53 to 56% [17][18] , comparable to survival rates observed with AR.…”

“…This technique as originally described, and still in use in some centers, is nonselective in nature, meaning all vessels found to cross the intertwin membrane were photocoagulated 17,18 . Survival with this approach is reported to be 53 to 56% [17][18] , comparable to survival rates observed with AR. An intriguing finding which stimulated interest in this approach was the observation that newborn survivors treated by fetoscopic laser appeared to have a lower incidence of head ultrasound or MRI abnormalities (5-7% vs. 14-25%) 5,[17][18][19][20] .…”