Fetoscopic laser ablation (FLA) for severe twin to twin transfusion syndrome (TTTS): does quintero stage influence outcome?

Abstract

Aim To evaluate the effects of Quintero stage at diagnosis on perinatal outcome in a single centre. Methods A cohort of consecutive monochorionic (MC) twin (MC) pregnancies complicated by severe TTTS (≤26 weeks) treated by fetoscopic laser ablation (FLA) (October 2004–June 2010). Results Of the 199 MC twins; 5% were Quintero stage II, 79% stage III & 16% stage IV. For the cohort overall the median gestational age (GA) at FLA was 20.1 weeks (IQR 18–22). The median interval from FLA to delivery was 87 days (IQR 54–101) & GA at delivery 33.7 weeks (IQR 30.3–34.9). There was no significant difference for the different stages of disease. Survival or one or more baby to 28 days was 92% for stage II disease, 88% for stage III and 69% for stage IV. The perinatal mortality for each of the groups was 38%, 36% and 53% respectively. Thus there was a decrease in survival and increase in perinatal mortality with advancing Quintero stage. This was not however, statistically significant. Univariate logistic regression analysis indicated that Quintero stage of disease had no effect on the survival of one or more babies to 28 days p=0.06 nor perinatal mortality p=0.47. Conclusion These data indicate that Quintero stage of disease and timing of fetoscopic laser ablation do not affect pregnancy outcome in severe TTTS. This is in concordance with data from studies from the USA but in disagreement with other European studies.