Intrafetal Laser Therapy Is a Feasible Treatment for Different Fetal Conditions: A Systematic Review

Abstract

Introduction: Over the past years, intrafetal laser (IFL) therapy has been increasingly used in the management of various prenatal conditions. The aim of our research is to clarify the effectiveness and safety of this technique. Methods: A systematic review of the literature was carried out using MEDLINE/PubMed over a period of 20 years (2001-2021). Results: A total of 41 articles were selected in the literature search, including 194 cases of twin reversed arterial perfusion (TRAP) sequence, 56 cases of bronchopulmonary sequestrations (BPS), 5 cases of placental chorioangiomas (PCA), 11 cases of sacrococcygeal teratoma (SCT), and 103 cases of embryo reduction (ER) managed using IFL. In TRAP sequence, perfusion of the acardiac twin was successfully disrupted in all cases. Preterm premature rupture of membranes (p-PROM) occurred in 6 out of 79 pregnancies (7.5%), and preterm birth (PTB) in 36 out of 122 pregnancies (29.5%). In BPS IFL was successfully performed in all cases with no significant complications. The rate of p-PROM and PTB were respectively 3.2% and 12.5%. All PCA IFL treated cases resulted in successful pregnancy outcomes; no cases of p-PROM were reported, but the rate of PTB reached a peak of 60% due to fetal complications. In SCT cases, complete cessation of blood flow was achieved in 4 patients (36.4%); p-PROM occurred in two cases (18.2%), whereas the rate of PTB was 87.5%. In ER no intraoperative or major maternal complications were described in the literature. Rates of miscarriage and PTB differed between initial trichorionic triamniotic and dichorionic triamniotic triplet pregnancies. Discussion: Our analysis suggests that IFL is a feasible technique for the management of different fetal conditions. However, the overall risk of PTB and its related morbidity and mortality, ranges from 12.5% in BPS to 87.5% in SCT. This could aid in decision making during prenatal counselling. However final perinatal outcome depends on the severity of the disease itself.

The Management of Acardiac Twinning: Twin Reverse Arterial Perfusion Sequence – An International Survey

“…The prenatal management of TRAP sequence aims to prevent a very preterm birth of pump twin and maximize its probability of intact survival. In the absence of randomized controlled trials, management strategies have been based on meta-analyses and single-center case series [9][10][11]. In the absence of poor prognostic predictors, several authors propose expectant management with serial ultrasound (US) evaluation [7,12,13], while others favor an early prophylactic in utero intervention [14][15][16].…”