Endoscopic Laser Dichorionization of the Placenta in the Treatment of Severe Twin-Twin Transfusion Syndrome

Abstract

Objectives: To describe the results of a technique of laser ablation of placental vessels in the treatment of severe twin-twin transfusion syndrome (TTTS), which is characterized by separation of the fetoplacental vascular territories and dichorionization of the placenta. Patients and Methods: Descriptive analysis of TTTS cases treated with the endoscopic laser dichorionization of the placenta (ELDP) procedure. The variables evaluated were the occurrence of reversal of the donor-recipient phenotype, persistence of TTTS or twin anemia-polycythemia sequence (TAPS); gestational age at delivery; discharge from the hospital of at least 1 or 2 live neonates, and incidence of neurological alterations among survivors. Results: 67 patients were treated with the ELDP procedure. There was no persistence of TTTS, reversal of the donor-recipient phenotype or TAPS. The median gestational age at delivery was 33.0 (23.6-37.7) weeks. The rate of discharge from the hospital of at least 1 or 2 live neonates was 88.2% (67/76) and 71.1% (54/76), respectively. Among survivors, 17 (17/121 = 14.0%) children presented with neurodevelopmental alterations during clinical follow-up. Conclusions: The major contribution of this study was the demonstration that the ELDP technique appears to be associated with a low risk of persistence or recurrence of TTTS and TAPS.

Residual anastomoses in twin-twin transfusion syndrome after laser: the Solomon randomized trial

“…Unfortunately these investigators did not report placental injection studies. [11][12][13] Importantly, however, even after the Solomon procedure, we still found a clinically important number of residual anastomoses (19% in the overall Solomon group and 12% in Placentas with arterioarterial residual anastomoses, n (%) 6 (43) 4 (17) .09 3 (38) 2 (11) .10…”

Chorioamniotic membrane separation after fetoscopy in monochorionic twin pregnancy: incidence and impact on perinatal outcome

“…Fetoscopic surgery is the only treatment for TTTS and it may be indicated in selected cases of sIUGR. Despite its clear benefits, fetal surgery has inherent risks that could affect pregnancy outcome and is associated with increased risks of preterm prelabor rupture of membranes (PPROM) and preterm delivery.…”

Postnatal survival after endoscopic equatorial laser for the treatment of twin-to-twin transfusion syndrome

“…Only few studies have examined pregnancy and neonatal outcomes using equatorial laser for the treatment of TTTS [12][13][14][15][16] . A recent randomized controlled trial has shown that this approach, also called 'Solomon' technique, was associated with a similar dual survival and survival of at least one twin compared to the group treated with the selective technique.…”