Fetoscopic laser ablation therapy in monochorionic diamniotic twin pregnancies with twin-to-twin transfusion syndrome treated at a single centre over 10 years: a retrospective study

Abstract

Objectives To review experience with fetoscopic laser ablation of placental anastomoses to treat monochorionic diamniotic (MCDA) twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) in a single centre over a ten-year period. Methods A retrospective study on 142 MCDA twin pregnancies complicates by TTTS treated with equatorial laser ablation of placental anastomoses (2008–2018). Solomon technique was also applied after 2013. Survival rates, neonatal outcome, intraoperative and post-laser complications were recorded, and prognostic factors analysed. Results A total of 133 cases were included in the final analysis; 41 patients were at stage II (30.8%), 73 were at stage III (62.9%), while only 12 (9%) at stage I and two patients (1.7%) at stage IV. Solomon technique was applied in 39 cases (29.3%). Survival of both twins was 51.1% (68/133), of a single twin 20.3% (27/133), and of at least one 71.5% (95/133), with an overall survival of 61.3% (163/266). TAPS and recurrent TTTS occurred in 8 (6%) and 15 (11.3%) patients. Survival of both fetuses increased over time (44.6 vs. 57.3%). A posterior placenta (p<0.003) and the use of the Solomon technique (p<0.02) were more frequent in cases with survival of both fetuses, while TTTS recurrence was significantly associated to the loss of one or two fetuses (p<0.01). Such associations were confirmed at logistic regression analysis. Conclusions Survival of both twins can improve over time and seems to be favourably associated with a placenta in the posterior location and the use of the Solomon technique.

Solomon technique vs selective fetoscopic laser photocoagulation for twin–twin transfusion syndrome: systematic review and meta‐analysis of maternal and perinatal outcomes

“…Pregnancies treated with the Solomon technique delivered at a significantly earlier GA compared with those treated with SFLP (pooled MD, -0.625 weeks (95% CI, -0.90 to -0.35 weeks); P < 0.001), while there was no significant difference in the interval between laser surgery and delivery between the groups (P = 0.589). 21 Kanazawa (2021) 22 Knijnenburg (2021) 23 Kim (2021) 24 Lanna (2017) 25 van Klink (2016) 26 Slaghekke (2014) 13 Ruano (2013) 12 Baschat (2013) 27 Only first author of each study is given. A maximum of one star can be awarded for each numbered item within selection and outcome categories.…”

Anesthesia for fetal operative procedures: A systematic review

“…Ninety-seven studies, accounting for 4,070 pregnancies, were included in the baseline characteristics and outcome analysis for MA ( 11 , 15 , 21 – 24 , 26 – 29 , 33 , 35 , 38 – 40 , 46 , 48 , 50 – 52 , 58 , 61 – 65 , 67 – 69 , 71 – 82 , 84 , 87 , 89 – 94 , 96 , 97 , 99 , 101 – 103 , 105 , 107 , 111 , 113 – 117 , 120 , 122 , 126 , 128 – 134 , 137 – 139 , 149 , 151 , 152 , 154 – 157 , 159 – 162 , 164 , 166 – 169 , 171 , 173 – 175 , 178 ). The aggregated mean GA at procedure, based on data from 85 studies (3,801 pregnancies), was 27.03 weeks ( 11 , 15 , 22 – 24 , 26 – 29 , 33 , 35 , 38 , 40 , …”

“…The mean LOH resulted to be 4.98 days, based on 24 studies involving 903 women ( 21 , 24 , 28 , 29 , 40 , 46 , 52 , 64 , 73 , 77 , 84 , 90 , 91 , 93 , 99 , 105 , 114 , 115 , 120 , 134 , 137 , 149 , 155 , 173 ). Sixty-four studies, with 3,032 pregnancies, resulted in an aggregated mean GA at delivery of 33.39 weeks ( 11 , 22 , 27 – 29 , 33 , 39 , 40 , 46 , 50 , 51 , 58 , 61 , 64 , 65 , 69 , 73 – 78 , 80 , 81 , 87 , 90 – 93 , 94 , 96 , 99 , 101 , 102 , 105 , 107 , 113 – 117 , 120 , 122 , 130 – 134 , 137 – 139 , 152 , 154 – 157 , 159 , 160 , 164 , …”

“…Ninety-five studies (3,905 pregnancies) were included for the comparative analysis of the anesthesia administration's routes ( 11 , 15 , 21 – 24 , 26 – 29 , 33 , 35 , 38 – 40 , 46 , 48 , 50 – 52 , 58 , 61 – 65 , 67 – 69 , 71 – 82 , 84 , 87 , 89 – 94 , 96 , 97 , 99 , 101 – 103 , 105 , 107 , 111 , 113 – 116 , 120 , 122 , 126 , 128 – 134 , 137 – 139 , 149 , 151 , 152 , 154 – 157 , 159 – 162 , 164 , 166 – 169 , 171 , 173 – 175 ). No statistically significant differences were found in the baseline characteristics and outcomes between patients receiving loco-regional and general anesthesia ( Table 1 ).…”

“…Twenty-nine studies, accounting for 2,964 pregnancies with twin-to-twin transfusion syndrome (TTTS), were included ( 22 , 27 , 48 , 61 , 64 , 69 , 72 , 79 , 87 , 94 , 96 , 102 , 105 , 107 , 114 , 117 , 122 , 131 – 133 , 149 , 155 , 156 , 164 , 167 – 169 , 174 ). All but one study performed MA; the one study describing laser ablation of placental anastomosis under MFA was excluded from the sub analysis ( 135 ).…”