Stage-Related Outcome after Fetoscopic Laser Ablation in Twin-to-Twin Transfusion Syndrome

Abstract

Aim: To review the perinatal outcome of twin-to-twin transfusion syndrome (TTTS) treated with fetoscopic laser coagulation in a developing country with detailed analysis according to the stage of the syndrome. Methods: This was a retrospective study of 85 TTTS cases treated with fetoscopic laser coagulation at the Fetal Diagnosis and Treatment Unit of Istanbul Faculty of Medicine between January 2006 and March 2013. Results: The surgical failure rate was 5.8% (5/85). Among all the cases of the total cohort, only 1 fetus survived in 27 pregnancies (31.8%), and both fetuses survived in 22 pregnancies (25.9%). In 49 pregnancies (57.6%) at least one fetus survived at the end of the neonatal period. The overall survival and live birth rates were 41.8% (71/170) and 56.4% (96/170), respectively, and they significantly decreased as the stage of disease increased. Delivery occurred before 32 weeks of gestation in 54 (63.5%) pregnancies. Logistic regression analysis showed that gestational age at delivery was the only independent factor, and the risk of nonsurvival significantly decreased with increasing age. Conclusion: Based on our experience, the outcome of fetoscopic laser coagulation of the placental anastomoses for TTTS became worse as the Quintero stage of the disease advanced.

Outcome following selective fetoscopic laser ablation for twin to twin transfusion syndrome: an 8 year national collaborative experience

“…As outlined in Table 2, our perinatal survival rates are comparable to those published internationally [13,[18][19][20][21][22][23][24][25][26][27][28][29][30]. Although perinatal outcomes within this cohort may differ slightly from other single-center international figures, our results are within the 95% confidence intervals for range of estimates of outcomes for these centers.…”

Evolution of Stage 1 Twin-to-Twin Transfusion Syndrome (TTTS): Systematic Review and Meta-Analysis

“…The lowest survival rate was reported by the study by Has et al (2014), which included 12 pregnancies with stage 1 TTTS. The largest study, by Wagner et al (2009), included 20 pregnancies and reported a double survival rate of 65%.…”

“…Four studies (51 pregnancies) reported the survival rates in pregnancies with stage 1 TTTS that were managed by laser (Has et al, 2014;Müllers et al, 2015;Sundberg et al, 2012;Wagner et al, 2009 Figure 5). The lowest survival rate was reported by the study by Has et al (2014), which included 12 pregnancies with stage 1 TTTS.…”

Outcome reporting across randomized trials and observational studies evaluating treatments for twin–twin transfusion syndrome: systematic review

“…Two hundred and thirty studies were therefore deemed eligible after full‐text review. From these, all randomized trials ( n = 6) and the largest observational studies ( n = 94) were selected for analysis (Figure ). There were 13 case–control studies, 32 prospective cohort studies and 49 retrospective cohort studies.…”