Prognostic factors in severe twin–twin transfusion syndrome treated by endoscopic laser surgery

Abstract

Fetoscopic laser coagulation of the placental vascular anastomoses in severe mid-trimester twin-twin transfusion is a potentially corrective and effective, minimally invasive procedure. Doppler investigation of the umbilical and fetal circulations provides important information on the fetal condition, prognosis and therapeutic effects of the intervention. Signs of congestive heart failure in the recipient may reduce the probability of survival, whereas increased placental resistance in the donor before the procedure is not necessarily associated with a reduction in the probability of survival after laser coagulation.

Mathematical modeling of twin–twin transfusion syndrome Asli Umur and Michael G Ross

“…We believe that it better preserves the placental territory of each twin. Although our numbers are still small, this is our initial experience, our general survival rate in a long term follow-up was 50%, this compares to the number found in the international literature that varies from 53 to 56% 5,6,12,14,15 . Placentas inserted in the anterior uterine wall are considered a challenge because it makes more difficult to choose the entry point, in order to reach the placenta at a 90 degree angle.…”

Comparison between laparoscopically assisted and standard fetoscopic laser ablation in patients with anterior and posterior placentation in twin‐twin transfusion syndrome: a single center study

“…A distribution plot of the laser time showed no evidence of a skewed pattern. The number of anastomoses ablated was not significantly different between the three groups [7 (5-12) in SAP vs 6 (5-11) in LAP and 8 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16) in SPP, p = 0.47]. There were no significant differences seen between the three groups in terms of the amount of fluid either removed or infused during the case.…”

“…While several different techniques have been tried to solve this problem, most of them increase the risk of direct placental injury, increase the risk of marginal placental bleeding, and result in less than optimal trochar positioning leading to incomplete laser therapy. 5,[8][9][10][11] An open-entry, laparoscope-assisted fetoscopy technique (LAP) has been reported to improve placental visualization in patients with an anterior placenta. 7,12 There are limited outcome data available, and the maternal complication rate was reported by one group to be as high as 7%, 12 making the use of this technique somewhat controversial.…”

Treatment Options for the Twin–Twin Transfusion Syndrome: A Review

“…In summary, amnioreduction normalizes amniotic fluid volume, prolongs pregnancy, improves placental perfusion and reduces maternal complications. Table 2 shows the reported perinatal survival rates (Bebbington & Wittman, 1989;Brown et al, 1989;Chescheir & Seeds, 1988;Cincotta et al, 1996;DeLia et al, 1999;Dennis & Winkler, 1997;Elliot et al, 1991;Gonsoulin et al, 1990;Hecher et al, 1999;Hecher et al, 2000;Nageotte et al, 1989;Patten et al, 1989;Pinette et al, 1993;Pretorius et al, 1988;Quintero et al, 2000;Quintero et al, 2000;Saunders et al, 1992;Thilaganathan et al, 2000;Trespidi et al, 1997;Urig et al, 1990;Ville et al, 1994;Zikulnig et al, 1999).…”