Fetal and Maternal Complications after Selective Fetoscopic Laser Surgery for Twin-to-Twin Transfusion Syndrome: A Single-Center Experience (original) (raw)
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Fetoscopic laser therapy for twin-twin transfusion syndrome before 17 and after 26 weeks' gestation
American Journal of Obstetrics and Gynecology, 2013
The purpose of this study was to compare perinatal outcomes of pregnancies that undergo "early" (Ͻ17 weeks' gestation) or "late" (Ͼ26 weeks' gestation) fetoscopic laser ablation of placental vascular anastomoses for twin-twin transfusion syndrome (TTTS) with "conventional" cases that were treated at 17-26 weeks' gestation. STUDY DESIGN: We conducted a single center, retrospective analysis of 325 consecutive pregnancies that underwent fetoscopic laser therapy for severe TTTS. RESULTS: Twenty-four "early," 18 "late," and 283 "conventional" pregnancies with severe TTTS underwent laser therapy. Fetoscopy duration , gestation at delivery, survival rate, and complications were comparable among groups, except for preterm premature rupture of membranes at Ͻ7 days after laser therapy, which was more common in the "early" group than in either of the other 2 groups. CONCLUSION: Laser therapy for TTTS at Ͻ17 or Ͼ26 weeks' gestation has similar outcomes to procedures done at 17-26 weeks' gestation. We suggest that conventional gestational age guidelines of 16-26 weeks for laser therapy for TTTS should be reevaluated.
Fetoscopic laser treatment of twin-to-twintransfusion syndrome (TTTS)
PubMed, 2008
The aim of this study was to report the results of the first 10 cases of fetoscopic laser surgery for twin-to-twin transfusion syndrome by the Rotunda Hospital Fetal Treatment Programme. All cases of severe TTTS managed by our team from 2006 to 2007 were included. All fetoscopic laser surgeries were performed by a single specialist in fetal medicine. All pregnancies were followed up to pregnancy completion and a minimum of six weeks neonatal life. Laser surgeries were performed with ultrasound guidance and percutaneously using local anaesthesia via a 2.8mm rigid fetoscope. Selective laser ablation of placental vessels was accomplished with a neodymium:YAG laser. The first 10 cases of severe TTTS managed by our team are reported. Laser ablation of placental vessels was accomplished successfully in all cases. Two pregnancies were complicated by preterm premature rupture of membranes before 22 weeks and both pregnancies were lost. Of the remaining 16 fetuses, one was diagnosed with significant ventriculomegaly postoperatively and underwent selective termination in the United Kingdom. The overall intact neonatal survival rate was 65%. Fetoscopic laser ablation of placental vessels for severe twin-to-twin transfusion syndrome is now available in Ireland, and our programme has delivered results that are in keeping with international best practices in this regard.
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2013
To document perinatal outcomes following use of the 'Solomon technique' in the selective photocoagulation of placental anastomoses for severe twin-twin transfusion syndrome (TTTS). Between January 2010 and July 2012, data were collected from 102 consecutive monochorionic twin pregnancies complicated by severe TTTS that underwent fetoscopic laser ablation at four different centers. We compared outcomes between subjects that underwent selective laser coagulation using the Solomon technique (cases) and those that underwent selective laser coagulation without this procedure (controls). Of the 102 pregnancies examined, 26 (25.5%) underwent the Solomon technique and 76 (74.5%) did not. Of the 204 fetuses, 139 (68.1%) survived up to 30 days of age. At least one twin survived in 82 (80.4%) pregnancies and both twins survived in 57 (55.9%) pregnancies. When compared with the control group, the Solomon-technique group had a significantly higher survival rate for both twins (84.6 vs 46...
The Open Medical Devices Journal, 2012
Fetoscopic laser surgery for severe twin-twin transfusion syndrome (TTTS) has become the optimal treatment choice since the release of the Eurofetus randomized clinical trial. These techniques have been adopted throughout the globe, and many institutions have instituted or will soon institute fetoscopic laser surgery procedures; however, laser surgery has a steep learning curve because of the following: challenging placental location, complex and unexpected communicating anastomoses, residual anastomoses after surgery, or discolored amniotic fluid. We have been performing laser surgery since 2002 in Japan; to date, we have compiled a series of 170 cases. Our data indicates a 78% of overall survival with 5% neonatal morbidity, 63% of survival of both twins, and 93% survival of at least one twin. The recurrent TTTS rate was 1% and the residual vessel rate was 3%. To improve the learning curve of laser surgery, the employment of various techniques is recommended to achieve a successful surgical outcome: (1) Mapping: before laser ablation, a very thorough mapping of vascular anastomoses should be done, and should be repeated after ablation; (2) Sequential order: obliteration of arterio-venous anastomoses from donor to recipient should be done first to avoid donor hypotension and/or anemia; (3) Trocar (cannula) assisted technique: Trocar assisted technique: Using gentle indent the trocar to the placenta by withdrawing the scope shortly, then anastomoses could be ablated easily; (4) Line method: to avoid residual anastomoses, the laser should draw a virtual line at the hemodynamic equator; The operator must be careful not to miss small anastomoses. These techniques can help achieve a successful outcome for fetoscopic laser surgery and improve the outcome for cases of severe TTTS.
American Journal of Obstetrics and Gynecology, 2015
Background: Endoscopic laser coagulation of placental anastomoses is the first-line treatment for severe twin-to-twin transfusion syndrome (TTTS). A recent randomized controlled trial reported that laser coagulation along the entire vascular equator was associated with a similar dual survival and survival of at least one twin compared to the group treated with the selective technique. In addition, there was a significantly lower incidence of postoperative recurrence of TTTS and development of twin anemia-polycytemia sequence (TAPS) in the equatorial group. Objective: To report on neonatal survival in TTTS pregnancies treated with endoscopic laser using the equatorial technique and to examine the relationship between preoperative factors and twin loss. Study design: Endoscopic equatorial laser was carried out as the primary treatment for TTTS in all consecutive monochorionic diamniotic twin pregnancies referred at a single fetal surgery Centre over a 4 years' period. All visible placental anastomoses were coagulated and additional laser ablation of the placental tissue between the coagulated vessels was carried out. Pre-laser ultrasound data, peri-procedural complications, pregnancy outcome and postnatal survival at hospital discharge were recorded and analysed. Results: A total of 106 pregnancies were treated during the study period. Median gestational age at laser was 19.7 (range 15.1-27.6) weeks. There was postoperative recurrence of TTTS or development of TAPS in 2 (1.9%) and 2 (1.9%) cases, respectively. The survival rates of both and at least one twin were 56.6% and 83.0%, respectively. Donor survival was significantly lower compared to the recipient co-twin (64.2% vs 75.5%, respectively; p<0.05). The rate of fetal death, which was the most common cause of twin loss, was significantly higher in donors compared to recipient 4 fetuses (23.6% vs 10.4%, respectively; p<0.05). In cases with absent or reversed end-diastolic velocity in the donor umbilical artery, dual and donor survival rates were significantly lower compared to the remaining TTTS pregnancies (40.0% vs 64.8% and 40.0% vs 76.1%, respectively; p<0.05). There were no significant differences between the two groups in the survival of at least one twin and in the recipient survival. Conclusions: Endoscopic equatorial laser was associated with a survival of both and at least one twin of about 55% and 83%, respectively, and with a low rate of recurrent TTTS and TAPS. In addition, the preoperative finding of abnormal donor umbilical artery Doppler identified a subgroup of TTTS pregnancies with a lower dual survival rate due to increased intrauterine mortality of donor twins.
American journal of obstetrics and gynecology, 2018
An improved survival and quality of life for neonatal survivors after fetoscopic laser therapy for twin-twin transfusion syndrome has been reported. However, little is known about the medium-term maternal effects after fetoscopic laser therapy with respect to reproductive and gynecologic outcomes. The objective of this study was to document reproductive, obstetric, gynecological, and psychological outcomes in women who underwent fetoscopic laser therapy for twin-twin transfusion syndrome. This was a monocentric controlled study on consecutive women who underwent fetoscopic laser therapy for twin-twin transfusion syndrome between 2007 and 2013 at the University Hospitals Leuven (cases; n = 198). Controls were women followed up during the same time period for an uncomplicated monochorionic diamniotic twin pregnancy and with an uneventful course (controls; n = 211). All patients received a questionnaire inquiring on their fertility, later pregnancies, and gynecological outcomes. The re...