Outcome following selective fetoscopic laser ablation for twin to twin transfusion syndrome: an 8 year national collaborative experience

Müllers, Sieglinde; McAuliffe, Fionnuala M.; Kent, Etaoin; Carroll, Stephen; Mone, Fionnuala; Breslin, Noelle; Dalrymple, Jane; Mulcahy, Cecelia; O’Donoghue, Keelin; Martin, A. J. P.; Malone, Fergal D.

doi:10.1016/j.ejogrb.2015.05.019

Cited by 27 publications

(14 citation statements)

References 37 publications

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“…However, we do not have any nationwide data for comparison, as there is no national population registry in Germany, and intrauterine surgery is not listed in German hospital quality reports. Our study also shows that, for small countries, international centralization may be an alternative, which avoids patients having to go through a local learning curve (smaller national centers that started performing laser therapy have described similar learning curves to ours). This is emphasized by our referral pattern from several European countries, the majority from Norway, but also from countries which are further away, for example in the Middle East.…”

Section: Discussionsupporting

confidence: 74%

Fetoscopic laser coagulation in 1020 pregnancies with twin–twin transfusion syndrome demonstrates improvement in double‐twin survival rate

Diehl

Diemert

Grasso

et al. 2017

Ultrasound in Obstet & Gyne

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Section: Discussionsupporting

confidence: 74%

Fetoscopic laser coagulation in 1020 pregnancies with twin–twin transfusion syndrome demonstrates improvement in double‐twin survival rate

Diehl

Diemert

Grasso

et al. 2017

Ultrasound in Obstet & Gyne

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“…No maternal deaths (Clavien‐Dindo grade V) due to fetal surgery were reported in any study (10 596 procedures). One study reported a patient at 20 weeks' gestation experiencing a cardiorespiratory arrest prior to fetoscopy for laser photocoagulation. The cause was considered to be a combination of morbid obesity, spinal anaesthesia, and aortocaval compression and not related to the procedure, which had not commenced.…”

Section: Resultsmentioning

confidence: 99%

“…All complications were independently graded according to the 86 reported a patient at 20 weeks' gestation experiencing a cardiorespiratory arrest prior to fetoscopy for laser photocoagulation.…”

Section: What Does This Study Add?mentioning

confidence: 99%

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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“…However, because of the decreasing trend in the rate of severe NDI, attention is shifting toward more subtle problems, including mild CP and neurocognitive impairments. Minor impairments can have a significant impact on the care and educational requirements of children and are reported in up to 30% of TTTS survivors [25,47,48,[88][89][90]. In order to gain more information on the exact burden and severity of NDI after laser surgery for TTTS, we encourage international collaboration to obtain larger sample sizes and statistical power, using a standardized follow-up regimen including uniform and clearly defined criteria for long-term neurodevelopmental impairment [91].…”

Section: Mild Neurodevelopmental Impairmentmentioning

confidence: 99%

Twin-twin transfusion syndrome in the era of fetoscopic laser surgery: antenatal management, neonatal outcome and beyond

Spruijt

Lopriore

Steggerda

et al. 2020

Expert Review of Hematology

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Introduction: Twin-twin transfusion syndrome (TTTS) is a devastating complication of monochorionic twin pregnancy and remains a major challenge for worldwide fetal medicine specialists. In TTTS, intertwin transfusion through vascular anastomoses in the shared placenta leads to severe hemodynamic imbalance. This review summarizes the current knowledge of TTTS. Areas covered: The most recent insights concerning the management of TTTS, as well as fetal and neonatal complications are described. Relevant articles were selected based on a Pubmed search using the keywords below. Understanding of the underlying pathophysiology has improved greatly as a result of placental injection studies. Advancements in antenatal management have led to increased perinatal survival and a decreased incidence of neonatal complications, including brain injury and neurodevelopmental impairment. Expert opinion: Further opportunities for improvement comprise technological innovations in laser procedures and the prevention of preterm rupture of membranes with subsequent prematurity. A noninvasive treatment such as high-intensity focused ultrasound (HIFU) seems to hold promise for the future treatment of TTTS. Fetal MRI studies are important to improve our understanding of fetal brain injury and should relate their findings to long-term neurodevelopment. International collaboration and centralization of care are of paramount importance to ensure the best care for our patients.

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Outcome following selective fetoscopic laser ablation for twin to twin transfusion syndrome: an 8 year national collaborative experience

Cited by 27 publications

References 37 publications

Fetoscopic laser coagulation in 1020 pregnancies with twin–twin transfusion syndrome demonstrates improvement in double‐twin survival rate

Fetoscopic laser coagulation in 1020 pregnancies with twin–twin transfusion syndrome demonstrates improvement in double‐twin survival rate

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

Twin-twin transfusion syndrome in the era of fetoscopic laser surgery: antenatal management, neonatal outcome and beyond

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