Fetoscopic laser coagulation for twin-twin transfusion syndrome before 17 weeks' gestation: laser data, complications and neonatal outcome

Lecointre, Lise; Sananès, Nicolas; Weingertner, Anne Sophie; Köhler, M.; Guerra, Fernando; Fritz, G.; Viville, B.; Langer, B.; Nisand, I.; Favre, R.

doi:10.1002/uog.13375

Cited by 27 publications

(38 citation statements)

References 15 publications

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“…The laser photocoagulation technique has already been described in a previous paper [19]. Amnioinfusion was always performed to facilitate access to the vascular equator.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of the Utility of in utero Treatment of Twin Anemia-Polycythemia Sequence

Sananès¹,

Veujoz²,

Séverac

et al. 2015

Fetal Diagn Ther

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Objective: The aim of this study is to evaluate the interest in the in utero treatment of twin anemia-polycythemia sequence (TAPS). Methods: The obstetrical and neonatal data on all cases of TAPS followed up in our institution between 2006 and 2013 were reviewed. Statistical analyses were conducted using Bayesian methods. Results: Twenty cases of TAPS were included. Laser therapy or intrauterine transfusion (IUT) was performed on the donor twin in 9 cases. Eleven cases were included in the ‘nontreated' group (managed expectantly or diagnosed at birth). The gestational age at diagnosis was lower in the group with treated TAPS [difference (diff) = -22.20 days (-57.13, 14.28), probability (Pr) (diff >0) = 10.6%]. The rate of preterm premature rupture of membranes was higher in the group with treated TAPS [diff = 22.5% (-14, 57), Pr (diff >0) = 89%], but overall mortality was similar. The interval between diagnosis and delivery was longer [diff = 44.37 days (9.41, 77.90), Pr (diff >0) = 99.2%], the TAPS resolution rate was higher [diff = 49.9% (12, 81), Pr (diff >0) = 99.4%], and the neonatal transfusion rate was lower [diff = -30.5% (-60, 0), Pr (diff >0) = 2.6%] in the treated group. Conclusion: In utero treatment for TAPS is associated with a higher resolution rate of TAPS and a longer time between diagnosis and birth, but overall mortality is the same as with expectant management.

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“…The laser photocoagulation technique has already been described in a previous paper [19]. Amnioinfusion was always performed to facilitate access to the vascular equator.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of the Utility of in utero Treatment of Twin Anemia-Polycythemia Sequence

Sananès¹,

Veujoz²,

Séverac

et al. 2015

Fetal Diagn Ther

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“…2,5,28,29 However, this may still represent an underestimation of the true rate of early-onset TTTS, as cases of liquor discrepancy leading to intrauterine fetal death may not be classified as TTTS. Of cases treated with laser; two-thirds of fetuses survived.…”

Section: Discussionmentioning

confidence: 99%

“…1 TTTS affects 8-15% MCDA pregnancies, with 7-23% of cases requiring treatment prior to 18 weeks' gestation in large prospective studies ('earlyonset' TTTS). [2][3][4][5] The severity of TTTS is categorised typically using Quintero Stages I-V, based on standardised ultrasound findings. 6 This staging system was validated for diagnosis of TTTS from 18 weeks' gestational age (GA) onwards but is not prognostic.…”

Section: Introductionmentioning

confidence: 99%

Early‐onset twin–twin transfusion syndrome: Case series and systematic review

Mylrea‐Foley

Shaw

Harikumar

et al. 2019

Australas J Ultrason Med

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Introduction: Data on the outcomes of early-onset twin-twin transfusion syndrome (TTTS), diagnosed before 18 weeks gestational age (GA), are sparse. We aimed to review the diagnosis, management and outcomes of early-onset TTTS. Material and methods: Pregnancy records at a single referral unit 2010-6 were reviewed. In early-onset TTTS cases, data for pregnancy characteristics, interventions and outcomes were collected. PubMed and Scopus databases were searched for studies including pregnant women with early-onset TTTS. The primary outcome measure was livebirths. Results: Case series: 58 cases of early-onset TTTS 2010-6, with full outcome data in 44. Diagnostic criteria were variable. Median GA at intervention was 17 +4 (range 15 +0 -28 +1 ); 67% of patients had laser therapy (39/58). Overall survival: 60% (53/88). At least one livebirth: 86% (38/44), Two livebirths: 34% (15/44); No survivors: 14% (6/44). GA at delivery was 32 +1.5 (range 16 +2 -37 +4 ). Systematic review: 16 studies included (n = 171 pregnancies). Diagnostic criteria varied widely: 79% of studies used Quintero staging. Most offered laser (89%) at median 17 +0 weeks (range 16 +0 -21 +6 ). GA at delivery was 23 +0 -39 +5 weeks. Overall survival: 69% (129/186). At least one livebirth: 74% (127/171). Two livebirths: 59% (55/93). No survivors: 26% (44/171). Conclusions: In comparison with the commonly accepted overall survival for TTTS treated after 18 weeks of 60-90%, outcomes in early-onset TTTS were at the lower bound of this range. Gestational age at intervention is similar to that of later onset TTTS, indicating a lack of therapeutic options when a diagnosis is made before 18 weeks.

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“…There is, however, increasing evidence that laser ablation above and below these arbitrary cutoffs have comparable outcomes in survival rates and complication rates. [51][52][53][54] Data are limited on the impact of intervention for stage I TTTS. In the Eurofetus Trial, there were only 11 stage I cases, 6 laser and 5 AR cases and they were analyzed together with the stage II cases.…”

Section: Treatmentmentioning

confidence: 98%

Diagnosis and Management of Twin-Twin Transfusion Syndrome

Johnson

2015

Clinical Obstetrics &Amp; Gynecology

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Twin-twin transfusion syndrome (TTTS) affects 10% to 15% of monochorionic pregnancies. In the absences of timely diagnosis and intervention perinatal loss or long term developmental delay can be expected in over 90% of cases. Establishing chorionicity in the first trimester followed by serial ultrasounds beginning at 16 weeks of gestation and intervention with placental laser ablation before the development of advance disease overall survival rates can be expected in 70% to 80% of cases.

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Fetoscopic laser coagulation for twin-twin transfusion syndrome before 17 weeks' gestation: laser data, complications and neonatal outcome

Abstract: Objective To compare laser data, complications and neonatal outcome in pregnancies that undergo 'early' (≤ 17 weeks' gestation)

Cited by 27 publications

References 15 publications

Evaluation of the Utility of in utero Treatment of Twin Anemia-Polycythemia Sequence

Evaluation of the Utility of in utero Treatment of Twin Anemia-Polycythemia Sequence

Early‐onset twin–twin transfusion syndrome: Case series and systematic review

Diagnosis and Management of Twin-Twin Transfusion Syndrome

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