Laser therapy and serial amnioreduction as treatment for twin-twin transfusion syndrome: a metaanalysis and review of literature

Rossi, A. Cristina; D’Addario, Vincenzo

doi:10.1016/j.ajog.2007.09.043

Cited by 186 publications

(137 citation statements)

References 23 publications

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“…Laser treatment resulted in a later delivery (33.3 versus 29 weeks), a better survival rate at 6 months of age (at least one survivor in 76% compared to 51%), and less neurological impairment (intraventricular hemorrhage grades III or IV, 1% versus 6%; cystic periventricular leukomalacia, 6% versus 14%; infants alive without major complications at 6 months, 52% versus 31%). Later meta-analyses [72,73] and a Cochrane review [74] confirmed this including other series; therefore, laser is the current standard of care.…”

Section: Twin-twin-transfusion Syndromementioning

confidence: 77%

The use of endoscopy in fetal medicine

Beck¹,

Pexsters²,

Gucciardo³

et al. 2010

Gynecol Surg

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We aimed to review the state of affairs in the field of embryo-fetoscopy as well as its instrumental requirements. Today, endoscopic procedures of limited complexity are easily possible within the amniotic cavity. Embryoscopy is typically done for diagnostic purposes, such as the demonstration of external anomalies very early in pregnancy and/or obtaining embryonic tissues in recurrent miscarriages. Fetoscopy is the direct visualization of the amniotic cavity from the second trimester onwards. Its principal indications are complications of monochorionic twinning and severe congenital diaphragmatic hernia. There is level I evidence that fetoscopic laser surgery for twintwin-transfusion syndrome is superior over amniodrainage. Fetoscopic endoluminal tracheal occlusion is done for severe diaphragmatic hernia. Whether tracheal occlusion yields better outcomes than expectant management during pregnancies is currently being investigated in a randomized trial. There are a number of less common procedures discussed as well. Overall, maternal risks of embryofetoscopy are minimal. The most frequent complication is rupture of the membranes and as a consequence preterm delivery. Fetal surgery seems safe and has, therefore, become a clinical reality. Although the stage of technical experimentation is over, most interventions remain investigational. Inclusion of patients into trials whenever possible should be encouraged, rather than building up casuistic experience.

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Section: Twin-twin-transfusion Syndromementioning

confidence: 77%

The use of endoscopy in fetal medicine

Beck¹,

Pexsters²,

Gucciardo³

et al. 2010

Gynecol Surg

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“…Laser ablation of placental vessels (LAPV) is the treatment of choice for severe twin-twin transfusion syndrome (TTTS) [1,2,3,4]. Since a pioneering report described successful procedures performed by De Lia et al [5] more than 20 years ago, the technique has undergone several modifications [6,7,8,9,10].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Laser Dichorionization of the Placenta in the Treatment of Severe Twin-Twin Transfusion Syndrome

Peralta

Molina²,

Gómez³

et al. 2013

Fetal Diagn Ther

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Objectives: To describe the results of a technique of laser ablation of placental vessels in the treatment of severe twin-twin transfusion syndrome (TTTS), which is characterized by separation of the fetoplacental vascular territories and dichorionization of the placenta. Patients and Methods: Descriptive analysis of TTTS cases treated with the endoscopic laser dichorionization of the placenta (ELDP) procedure. The variables evaluated were the occurrence of reversal of the donor-recipient phenotype, persistence of TTTS or twin anemia-polycythemia sequence (TAPS); gestational age at delivery; discharge from the hospital of at least 1 or 2 live neonates, and incidence of neurological alterations among survivors. Results: 67 patients were treated with the ELDP procedure. There was no persistence of TTTS, reversal of the donor-recipient phenotype or TAPS. The median gestational age at delivery was 33.0 (23.6-37.7) weeks. The rate of discharge from the hospital of at least 1 or 2 live neonates was 88.2% (67/76) and 71.1% (54/76), respectively. Among survivors, 17 (17/121 = 14.0%) children presented with neurodevelopmental alterations during clinical follow-up. Conclusions: The major contribution of this study was the demonstration that the ELDP technique appears to be associated with a low risk of persistence or recurrence of TTTS and TAPS.

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“…Laser therapy is also associated with better outcomes compared with serial amnioreduction (Table 1). 3 In this review, the diagnosis, assessment and management of TTTS are described.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Management of Twin-Twin Transfusion Syndrome

Rossi¹,

Addario²

2012

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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Twin-twin transfusion syndrome (TTTS) is a complication unique to monochorionic twin pregnancies, in which the two twins share a common placenta and unequal blood exchange from one twin (donor) to the cotwin occurs through placental arterovenous anastomoses. The diagnosis is posed with the sonographic detection of oligohydramnios in the donor's sac, as a consequence of hypovolemia, and polyhydramnios in the recipient's sac, resulting from hypervolemia. The severity of TTTS is assessed according to Quintero staging system, which is based on five stages that range from visualization of the donor's bladder to intrauterine demise of one or both twins. Because laser therapy has revealed the optimal treatment for TTTS, management of twins affected with TTTS consists in preoperative and postoperative assessment of the twins by ultrasound examination. The aim of this review was to describe the diagnosis and management of TTTS and discuss controversies and limitations of current literature.

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Laser therapy and serial amnioreduction as treatment for twin-twin transfusion syndrome: a metaanalysis and review of literature

Cited by 186 publications

References 23 publications

The use of endoscopy in fetal medicine

The use of endoscopy in fetal medicine

Endoscopic Laser Dichorionization of the Placenta in the Treatment of Severe Twin-Twin Transfusion Syndrome

Diagnosis and Management of Twin-Twin Transfusion Syndrome

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