Preoperative predictors of death in twin-to-twin transfusion syndrome treated with laser ablation of placental anastomoses

Twenty-Five Years of Fetoscopic Laser Coagulation in Twin-Twin Transfusion Syndrome: A Systematic Review

“…After full-text analysis a total of 34 studies were included in the time-based analysis [10,12,13,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48]. Twelve studies [5,49,50,51,52,53,54,55,56,57,58,59] presented data overlapping other series, of which one presented data relevant for the technique-based analysis [58]. …”

Donor Death After Selective Fetoscopic Laser Surgery for Twin–Twin Transfusion Syndrome

“…These include sequential selective laser photocoagulation, growth concordance, and normal Doppler studies in the donor fetus. [7][8][9][10] The risks for the occurrence of both donor and recipient fetal demise have also been reported in the past, but these reports were ascertained before the aforementioned improvements in fetoscopic laser surgery experience and technique. 6,8,9,11,12 Additionally, the timing of the occurrence of fetal demise after the fetoscopic laser surgery procedure remains unknown.…”

“…7-10 The risks for the occurrence of both donor and recipient fetal demise have also been reported in the past, but these reports were ascertained before the aforementioned improvements in fetoscopic laser surgery experience and technique. 6,8,9,11,12 Additionally, the timing of the occurrence of fetal demise after the fetoscopic laser surgery procedure remains unknown. The intrauterine death of one twin has previously been shown to be associated with a decreased risk of preterm birth, 13 but…”

“…The median procedure to death interval was 4 days (range 1-89 days). Risk factors for donor death were fetal growth discordance greater than 30% (odds ratio [OR] 6.7, 95% confidence interval [CI] 2-23), reverse end-diastolic velocity in the donor umbilical artery (OR 25.0, 95% CI 2-290), a marginal and velamentous cord insertion (OR 4.4, 95% CI [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], and an increased number of anastomoses (OR 1.2, 95% CI 1.1-1.5). All four donors with both fetal growth discordance greater than 30% and reverse enddiastolic velocity in the donor umbilical artery resulted in a demise.…”

Multiple Pregnancies

“…De Lia and Cruikshank ( 1989 ) found markedly greater vascular resistance in the donor. Bromley et al ( 1992 ) suggested from their experience with 12 sets that, when clinical manifestations were clear-cut at 20 weeks, the prognosis with conservative therapy was poorer than when the syndrome was diagnosed later in gestation, and this has been con fi rmed by several larger studies recently (Stamilio et al 2010 ;Bebbington 2010 ;Salomon et al 2010 ;Baschat et al 2010 ;Skupski et al 2010 ) . In general, TTTS has a poor prognosis if it remains untreated.…”