Perinatal Outcomes With Laser Surgery for Twin–Twin Transfusion Syndrome

Abstract

The aim of this tertiary hospital–based cohort study was to determine and compare perinatal outcome and neonatal morbidities of pregnancies with twin–twin transfusion syndrome (TTTS) before and after the introduction of a treatment program with laser ablation of placental communicating vessels. Twenty-seven pregnancies with Stage II–IV TTTS treated with amnioreduction were identified (amnioreduction group). The data were compared with that obtained from the first 31 pregnancies with Stage II–IV TTTS managed with laser ablation of placental communicating vessels (laser group). Comparisons were made for perinatal survival and neonatal morbidities including abnormalities on brain imaging. The median gestation at therapy was similar between the two groups (20 vs. 21 weeks, p = .24), while the median gestation at delivery was significantly greater in the laser treated group (34 vs. 28 weeks, p = .002). The perinatal survival rate was higher in the laser group (77.4% vs. 59.3%, p = .03). Neonatal morbidities including acute respiratory distress, chronic lung disease, requirement for ventilatory assistance, patent ductus arteriosus, hypotension, and oliguric renal failure had a lower incidence in the laser group. On brain imaging, ischemic brain injury was seen in 12% of the amnioreduction group and none of the laser group of infants (p = .01). In conclusion, these findings indicate that perinatal outcomes are improved with less neonatal morbidity for monochorionic pregnancies with severe TTTS treated by laser ablation of communicating placental vessels when compared to treatment by amnioreduction.

Outcome of twin–twin transfusion syndrome according to Quintero stage of disease: systematic review and meta‐analysis

“…Fifteen studies 29,31,34–38,42–45,49–51,53 reported information on Stage‐III TTTS treated with laser therapy.…”

Parenting Stress and Psychosocial Health in Mothers with Twin–Twin Transfusion Syndrome Managed with Laser Surgery: A Preliminary Study

“…Amnioreduction has been employed for many years in an attempt to prolong the pregnancy and enhance survival. More recently, however, laser ablation of the placental communicating vessels has been advocated as the preferred treatment for this condition with improved survival rates reported (Gray et al, 2006;Senat et al, 2004). It has been well described that survivors of TTTS are at high risk of long-term, neurodevelopmental disability including cerebral palsy (Cincotta et al, 2000;Lopriore et al, 2003).…”