Solomon versus selective fetoscopic laser photocoagulation for twin‐twin transfusion syndrome: A systematic review and meta‐analysis

Abstract

This meta-analysis aims to compare the perinatal outcome of twin-twin transfusion syndrome (TTTS) pregnancies undergoing selective versus vascular equator (Solomon) fetoscopic laser photocoagulation (FLP). We performed a systematic search in PubMed and Web of Science from inception up to 25 July 2021. Studies comparing the Solomon and selective techniques of FLP for treatment of TTTS pregnancies were eligible. Random-effects or fixed-effect models were used to pool standardized mean differences (SMD) and log odds ratio. Seven studies with a total of 1664 TTTS pregnancies (n = 671 undergoing Solomon and n = 993 selective techniques) were included. As compared to the selective FLP, Solomon was associated with a lower risk of recurrent TTTS compared to the selective technique (Log odds ratio[OR]: −1.167; 95% credible interval [CrI]: −2.01, −0.33; p = 0.021; I 2 : 67%). In addition, Solomon was significantly associated with a higher risk of placental abruption than the selective technique (Log [OR]: 1.44; 95% CrI: 0.45, 2.47; p = 0.012; I 2 : 0.0%). Furthermore, a trend for the higher risk of preterm premature rupture of membranes was observed among those undergoing Solomon (Log [OR]: 0.581; 95% CrI: −0.43, 1.49; p = 0.131; I 2 : 17%). As compared to selective FLP, the Solomon technique for TTTS pregnancies is associated with a significantly lower recurrence of TTTS; however, it significantly increases the risk of placental abruption. Key points What's already known about this topic?� There are conflicting findings regarding adverse effects of different fetoscopic laser photocoagulation techniques, especially Solomon.This systematic review and meta-analysis were registered in Prospero (CRD42021270044).

Perinatal outcomes of fetoscopic selective laser photocoagulation for spontaneous twin‐anemia polycythemia sequence

“…Complications of fetoscopic laser photocoagulation include placental abruption and preterm delivery. In cases of TTTS, placental abruption is more common following laser surgery 25 . In this case series, 3/13 (23%) cases were complicated by placental abruption with subsequent preterm delivery.…”

“…In cases of TTTS, placental abruption is more common following laser surgery. 25 In this case series, 3/13 (23%) cases were complicated by placental abruption with subsequent preterm delivery. The average gestational age at delivery among all patients was 29w3d, which likely reflects both the complexity of surgery but also the early gestational age at which surgery was performed.…”

Monochorionic Twins: TTTS, TAPS, and Selective Fetal Growth Restriction

“…Two meta-analyses comparing selective FLC to the Solomon technique for pregnancies complicated by TTTS have been recently published. 26,27 Both found the Solomon technique to be associated with a lower rate of recurrent TTTS, however, both also demonstrated a significant increase in the rate of placental abruption. One of the meta-analyses by D'Antonio et al 26 demonstrated a higher rate of survival for FLC using the Solomon technique when compared with selective FLC, but they also demonstrated that the Solomon technique was associated with an earlier gestational age at delivery.…”

“…Two meta-analyses comparing selective FLC to the Solomon technique for pregnancies complicated by TTTS have been recently published 26,27 . Both found the Solomon technique to be associated with a lower rate of recurrent TTTS, however, both also demonstrated a significant increase in the rate of placental abruption.…”