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Eur J Obstet Gynecol Reprod Biol. 2015 Aug;191:125-9. doi: 10.1016/j.ejogrb.2015.05.019. Epub 2015 May 30.

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

Author information

1
Obstetrics & Gynecology, Rotunda Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland. Electronic address: siglindemuellers@rcsi.ie.
2
UCD Obstetrics & Gynecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland.
3
Obstetrics & Gynecology, Rotunda Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland.
4
Obstetrics & Gynecology, National Maternity Hospital, Dublin, Ireland.
5
Obstetrics & Gynecology, Rotunda Hospital, Dublin, Ireland.
6
Obstetrics & Gynecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland.
7
Obstetrics and Gynecology, The Coombe Women and Infants University Hospital, Dublin, Ireland.

Abstract

OBJECTIVE:

With the recognition of the role of fetoscopic laser ablation for twin to twin transfusion syndrome (TTTS), there is a requirement for auditable standards for this technically challenging and specialized treatment. The purpose of this study is to report on the perinatal and medium-term neurodevelopmental outcomes following an 8-year national single center experience in the management of TTTS using the selective fetoscopic laser ablation technique.

STUDY DESIGN:

An audit of all cases of TTTS treated with selective laser ablation by a single national fetal medicine team was performed. Overall perinatal survival and medium-term neurodevelopmental outcomes were reported and correlated with gestational age at diagnosis, placental location, volume of amnio-reduction, Quintero staging and percentage inter-twin growth discordance. Procedure-related complications were recorded.

RESULTS:

The overall fetal survival for the first 105 consecutive cases of TTTS was 61% (128/210 fetuses). Dual survival occurred in 47% (49/105) of cases, and with a single survival rate of 28% (30/105), perinatal survival of least one infant was achieved in 75% (79/105) of cases. No correlation was found between any clinical or sonographic marker and perinatal outcome, although dual survival was noted to be significantly decreased with increasing Quintero stage (p=0.041). Currently, 86% of survivors have been reported to have a normal medium-term neurological outcome.

CONCLUSION:

Fetoscopic laser ablation is the established optimal treatment for severe twin to twin transfusion syndrome (TTTS). We report comparable short and medium-term outcomes following the selective fetoscopic technique comparing results from our national program with internationally published single-center outcomes, supporting the efficacy and safety of this treatment at our center.

KEYWORDS:

Fetal therapy; Neurodevelopmental outcome; Perinatal outcome; Selective fetoscopic laser ablation; Twin to twin transfusion syndrome

PMID:
26117441
DOI:
10.1016/j.ejogrb.2015.05.019
[Indexed for MEDLINE]

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