Maternal complications of fetoscopic laser photocoagulation (FLP) for treatment of twin-twin transfusion syndrome (TTTS)

Merz, Waltraut M.; Tchatcheva, K.; Gembruch, Ulrich; Kohl, Thomas

doi:10.1515/jpm.2010.061

Cited by 29 publications

(18 citation statements)

References 41 publications

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“…There was a severe complication rate (Clavien‐Dindo grade III or IV) of 4.5% in women undergoing open fetal surgery and 1.7% undergoing fetoscopic surgery. This is in keeping with a previous multi‐centre review of maternal complications following laser photocoagulation for TTTS, which found a 1.0% rate of severe complications and a 5.4% total rate of complications across all studies; however, when the authors only included studies, which systematically assessed maternal complications as a primary or secondary outcome, this rose to 1.8% for severe and 17.4% for all complications.…”

Section: Discussionsupporting

confidence: 87%

“…One single‐centre study of maternal outcomes following both open fetal and fetoscopic surgery performed between 1989 and 2003 found a number of short‐term morbidities . A systematic review of maternal complications following fetoscopic laser coagulation for twin‐to‐twin transfusion syndrome (TTTS) in 1785 patients treated between 1990 and 2009 observed an overall adverse event rate of 5.4% with severe complications in 1.0%. The aim of this study was to estimate the incidence of immediate and long‐term maternal complications of fetoscopic or open fetal surgery through a systematic review of the literature.…”

Section: Introductionmentioning

confidence: 99%

“…One single-centre study of maternal outcomes following both open fetal and fetoscopic surgery performed between 1989 and 2003 found a number of short-term morbidities. 6 A systematic review of maternal complications following fetoscopic laser coagulation for twin-to-twin transfusion syndrome (TTTS) in 1785 patients treated between 7…”

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confidence: 99%

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Maternal complications following open and fetoscopic fetal surgery: A systematic review and meta‐analysis

et al. 2019

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Objective To establish maternal complication rates for fetoscopic or open fetal surgery. Methods We conducted a systematic literature review for studies of fetoscopic or open fetal surgery performed since 1990, recording maternal complications during fetal surgery, the remainder of pregnancy, delivery, and after the index pregnancy. Results One hundred sixty‐six studies were included, reporting outcomes for open fetal (n = 1193 patients) and fetoscopic surgery (n = 9403 patients). No maternal deaths were reported. The risk of any maternal complication in the index pregnancy was 20.9% (95%CI, 15.22‐27.13) for open fetal and 6.2% (95%CI, 4.93‐7.49) for fetoscopic surgery. For severe maternal complications (grades III to V Clavien‐Dindo classification of surgical complications), the risk was 4.5% (95% CI 3.24‐5.98) for open fetal and 1.7% (95% CI, 1.19‐2.20) for fetoscopic surgery. In subsequent pregnancies, open fetal surgery increased the risk of preterm birth but not uterine dehiscence or rupture. Nearly one quarter of reviewed studies (n = 175, 23.3%) was excluded for failing to report the presence or absence of maternal complications. Conclusions Maternal complications occur in 6.2% fetoscopic and 20.9% open fetal surgeries, with serious maternal complications in 1.7% fetoscopic and 4.5% open procedures. Reporting of maternal complications is variable. To properly quantify maternal risks, outcomes should be reported consistently across all fetal surgery studies.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

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Maternal complications following open and fetoscopic fetal surgery: A systematic review and meta‐analysis

et al. 2019

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“…A recent review on the subject [12] reported that in the 3 existing studies with systematic assessment (379 patients) compared to those with unstructured approach, the rate of maternal complications after FLS was significantly higher (17.4 vs. 2.2%; p < 0.0001). The analysis quoted an overall rate of maternal events at 17%, with severe complications in 1.8%.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent analysis of the literature, the overall rate of adverse major and minor maternal events was 17%, with major events such as placental abruption and pulmonary or surgical sequelae occurring in less than 2% [12]. …”

Section: Introductionmentioning

confidence: 99%

Fetal and Maternal Complications after Selective Fetoscopic Laser Surgery for Twin-to-Twin Transfusion Syndrome: A Single-Center Experience

Rustico¹,

Lanna²,

Faiola³

et al. 2012

Fetal Diagn Ther

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Objective: To report the incidence of fetal and maternal complications after selective fetoscopic laser surgery for twin-to-twin transfusion syndrome (TTTS). Methods: A total of 150 cases of TTTS were treated from January 2004 to June 2009 (period 1, 2004–2006, 62 cases; period 2, 2007 to June 2009, 88 cases). Fetal complications (double and single intrauterine fetal death, recurrence of TTTS, twin anemia-polycythemia sequence (TAPS), reversal of TTTS, cerebral lesions in one twin) and maternal complications were recorded, and retrospectively analyzed. Results: Nineteen (12.6%), 58 (38.7%), 61 (40.7%) and 12 cases (8.0%) were classified preoperatively as Quintero stage I, II, III and IV, respectively. The anterior placenta was described in 73 cases (48.6%). Double and single fetal death occurred overall in 7.3 and 36.0% of cases, respectively. The rate of recurrence was 11.3%, of TAPS 3.3%, and of reversal of TTTS 1.3%. Cerebral lesions were diagnosed in 3 donors (2.0%). Eighteen cases (12.0%) of fetal complications had a second procedure (6 repeat laser, 4 serial amnioreduction, 8 bipolar cord coagulation). Pregnancies undergoing a second procedure delivered at a median gestational age of 30.2 weeks compared to 32.1 weeks for those not repeating (p = 0.04). Perinatal survival of at least one twin improved from 66.1 to 79.5% (p = 0.06) in the two consecutive periods. For every 10 laser surgeries performed, there was an average improvement of 1.5% in the predicted percentage of survival of at least one twin (OR 1.09, 95% CI 1.00–1.19). Major maternal complications occurred in 9 cases (6.0%), 3 of which required admission to intensive care unit. Conclusions: Fetal complications are common after fetoscopic laser surgery. In this experience, an increasing number of procedures improved the performance of a new fetoscopic laser center.

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A case of mirror syndrome caused by hydrops fetalis after fetoscopic laser photocoagulation

Kino

Maki

Ohhashi

et al. 2018

Clinical Case Reports

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Maternal complications of fetoscopic laser photocoagulation (FLP) for treatment of twin-twin transfusion syndrome (TTTS)

Abstract: High-quality data on maternal complications of FLP are rare. With systematic assessment, the rate of adverse events is significantly higher. Underreporting has to be assumed. Further studies are required to confirm these data.

Cited by 29 publications

References 41 publications

Maternal complications following open and fetoscopic fetal surgery: A systematic review and meta‐analysis

Maternal complications following open and fetoscopic fetal surgery: A systematic review and meta‐analysis

Fetal and Maternal Complications after Selective Fetoscopic Laser Surgery for Twin-to-Twin Transfusion Syndrome: A Single-Center Experience

A case of mirror syndrome caused by hydrops fetalis after fetoscopic laser photocoagulation

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