Outcome of fetoscopic laser ablation for twin‐to‐twin transfusion syndrome in dichorionic–triamniotic triplets compared with monochorionic–diamniotic twins

Argoti, Pedro; Papanna, Ramesha; Bebbington, Michael; Kahlek, Nahla; Baschat, Ahmet; Johnson, Anthony; Moise, Kenneth J.

doi:10.1002/uog.13369

Cited by 13 publications

(15 citation statements)

References 20 publications

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“…Ten of these 18 studies were excluded (see Appendix S1), leaving a total of eight studies included in the systematic review (Figure ). These eight studies included 126 triplet pregnancies (104 DCTA and 22 MCTA) treated with fetoscopic laser surgery of placental anastomoses for TTTS . The general characteristics of the studies included are reported in Table .…”

Section: Resultsmentioning

confidence: 99%

Perinatal outcome after fetoscopic laser surgery for twin‐to‐twin transfusion syndrome in triplet pregnancies

D’Antonio

Thilaganathan

Toms

et al. 2015

BJOG

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Objectives The introduction of fetoscopic laser surgery of placental anastomoses has led to a significant improvement of perinatal outcome of twin pregnancies affected by twin-to-twintransfusion syndrome (TTTS). To quantify the perinatal outcome and neurological morbidity in triplet pregnancies complicated by TTTS, which were treated with fetoscopic laser surgery.Search strategy Medline, Embase, Cinahl and Cochrane were searched.Selection criteria The outcomes observed were: fetal and perinatal survival, preterm birth and abnormal neurological outcome.Data collection and analysis Two authors reviewed all abstracts independently. Meta-analyses of proportions were used to combine data.Main results Eight studies (126 triplet pregnancies, 104 dichorionic-triamniotic [DCTA] and 22 monochorionictriamniotic [MCTA]) treated with fetoscopic laser surgery were included in this review. In DCTA and MCTA pregnancies, fetal losses were 18.9% and 28.9%, respectively; perinatal losses were 23.6% and 75.0%; preterm births <28 weeks of gestation were 16.9% and 37.1%; preterm births <32 weeks of gestation were 50.0% and 69.5%; at least one fetus survived in 95.4% and 88.9% of the pregnancies; at least two fetuses survived in 81.8% and 68.3% of the pregnancies; and in 55.9% and 48.4% pregnancies all triplets survived. Finally, the incidence of abnormal neurological outcomes ranged from 0 to 37% in DCTA and from 0 to 50% in MCTA triplets.Conclusions Both DTCA and MCTA triplet pregnancies affected by TTTS are at high risk of adverse perinatal outcome.

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Section: Resultsmentioning

confidence: 99%

Perinatal outcome after fetoscopic laser surgery for twin‐to‐twin transfusion syndrome in triplet pregnancies

D’Antonio

Thilaganathan

Toms

et al. 2015

BJOG

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“…The average gestational age at delivery among monochorionic triplets is in stark contrast to the average delivery timing (32–33 weeks gestation) reported with both uncomplicated triplet gestations, and monochorionic-diamniotic twins undergoing laser photocoagulation for severe twin–twin transfusion syndrome (TTTS), but similar to dichorionic-triamniotic pregnancies with FFTS. 1 19 20 A study comparing outcomes of laser photocoagulation in 16 dichorionic triplet gestations with 32 monochorionic twins found a similar early gestational age at delivery among dichorionic triplets, with a mean gestational age of delivery of 28.5 weeks compared with 31.9 weeks for their twin counterparts ( p = 0.02). 20 …”

Section: Discussionmentioning

confidence: 99%

Fetofetal Transfusion Syndrome in Monochorionic-Triamniotic Triplets Treated with Fetoscopic Laser Ablation: Report of Two Cases and A Systematic Review

Blumenfeld

Shamshirsaz

Belfort

et al. 2015

AJP Rep

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Objective This study aims to determine the clinical outcomes of monochorionic-triamniotic (MT) pregnancies complicated by severe fetofetal transfusion undergoing laser photocoagulation. Study Design We report two cases of MT triplets complicated by fetofetal transfusion syndrome (FFTS) and a systematic review classifying cases into different subtypes: MT with two donors and one recipient, MT with one donor and two recipients, MT with one donor, one recipient, and one unaffected triplet. The number of neonatal survivors was analyzed based on this classification as well as Quintero staging. Results A total of 26 cases of MT triples complicated by FFTS were analyzed. In 56% of the cases, the FFTS involved all three triplets, 50% of whom had an additional donor and 50% an additional recipient. Among the 24 cases that survived beyond 1 week after the procedure, the average gestational age of delivery was 29.6 weeks, and the average interval from procedure to delivery was 10.1 weeks. The overall neonatal survival rate was 71.7%, with demises occurring equally between donor and recipient triplets. Overall neonatal survival including survival of at least two fetuses occurred with equal frequency between the different groups. Conclusion Significant neonatal survival can be achieved in most cases of MT triplets with FFTS.

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“…The literature search identified 5 previous studies reporting data on MCTA pregnancies with FFTS treated by endoscopic laser surgery, and the combined data from these studies with ours are shown in table 3 and figure 2 [10][11][12][13]15] . In a total of 29 such pregnancies, the pooled survival rate of at least one baby was 80.6% (95% CI 64.9-92.4), and the overall survival for all babies was 57.5% (95% CI 36.2-77.4); there was significant heterogeneity between the studies.…”

Section: Synthesis With Results From Previous Studiesmentioning

confidence: 99%

“…In sFGR with abnormal Doppler findings in the umbilical artery of the affected fetus, there is a high risk of perinatal death and handicap for both twins; the management for affected pregnancies presenting at midgestation includes endoscopic laser coagulation of the inter-twin communicating placental vessels or cord occlusion of the FGR twin [4][5][6][7][8] . Few studies in a small number of patients have reported on endoscopic laser coagulation of communicating placental vessels for the management of FFTS in MC or dichorionic (DC) triamniotic (TA) triplet pregnancies complicated by FFTS [9][10][11][12][13][14][15][16] .…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Placental Laser Coagulation in Dichorionic and Monochorionic Triplet Pregnancies

Peeva

Chaveeva²,

Guevara³

et al. 2016

Fetal Diagn Ther

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Objective: To report the outcome of monochorionic (MC) and dichorionic (DC) triamniotic (TA) triplet pregnancies treated with endoscopic laser coagulation of the communicating placental vessels for severe feto-fetal transfusion syndrome (FFTS) and selective fetal growth restriction (sFGR). Methods: Laser surgery was performed at 18 (15-24) weeks' gestation in 11 MCTA and 33 DCTA pregnancies complicated by FFTS and 14 DCTA pregnancies complicated by sFGR. Data from our study and previous reports were pooled using meta-analytic techniques. Results: Survival of at least one baby and survival among all fetuses was 97.0 and 72.7% in DCTA pregnancies with FFTS, 78.6 and 52.4% in DCTA pregnancies with sFGR and 81.8 and 39.4% in MCTA pregnancies with FFTS. In the combined data from our study and previous reports, the pooled survival rates in 132 DCTA pregnancies with FFTS were 94.4 and 76.1%, and in 29 MCTA pregnancies with FFTS, they were 80.6 and 57.5%. Conclusions: Survival after laser surgery is higher in DC triplets with FFTS than in those with sFGR and in DC than in MC triplets with FFTS.

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Outcome of fetoscopic laser ablation for twin‐to‐twin transfusion syndrome in dichorionic–triamniotic triplets compared with monochorionic–diamniotic twins

Abstract: Objective To compare outcome of dichorionictriamniotic (DCTA) triplet gestations with that of a paired cohort of monochorionic-diamniotic (MCDA) twin gestations undergoing laser therapy for treatment of twin-to-twin transfusion syndrome (TTTS). Methods

Cited by 13 publications

References 20 publications

Perinatal outcome after fetoscopic laser surgery for twin‐to‐twin transfusion syndrome in triplet pregnancies

Perinatal outcome after fetoscopic laser surgery for twin‐to‐twin transfusion syndrome in triplet pregnancies

Fetofetal Transfusion Syndrome in Monochorionic-Triamniotic Triplets Treated with Fetoscopic Laser Ablation: Report of Two Cases and A Systematic Review

Endoscopic Placental Laser Coagulation in Dichorionic and Monochorionic Triplet Pregnancies

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