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  1. Article ; Online: Outcomes in a cohort of patients with Stage I twin-to-twin transfusion syndrome.

    Bebbington, M W / Tiblad, E / Huesler-Charles, M / Wilson, R D / Mann, S E / Johnson, M P

    Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology

    2010  Volume 36, Issue 1, Page(s) 48–51

    Abstract: ... I twin-to-twin transfusion syndrome (TTTS).: Methods: This was a retrospective review of all patients with TTTS referred ... was not offered to patients with Stage I disease.: Results: A total of 155 twin pregnancies were ... Objective: To determine pregnancy outcomes of patients who present with Stage ...

    Abstract Objective: To determine pregnancy outcomes of patients who present with Stage I twin-to-twin transfusion syndrome (TTTS).
    Methods: This was a retrospective review of all patients with TTTS referred to our institution between January 2005 and December 2006. Quintero criteria were used for staging. Laser ablation was not offered to patients with Stage I disease.
    Results: A total of 155 twin pregnancies were evaluated for TTTS during this period. Forty-two met the criteria for Stage I and were included in the analysis. The overall survival to discharge was 82%. The mean gestational age at the time of consultation was 20.9 +/- 0.4 weeks. A total of 23 cases (54.8%) underwent amnioreduction. Progression of TTTS requiring invasive therapy occurred in four cases. The mean gestational age at delivery was 32.5 +/- 0.62 weeks. When divided according to use of amnioreduction, there were no statistically significant differences between the groups for gestational age at delivery or for birth weight. Those Stage I cases with a CHOP cardiovascular score of 5 or higher delivered almost 3 weeks earlier than the remainder of the cohort.
    Conclusions: Progression of TTTS beyond Stage I occurred in only 9.5% of the cohort. Mean gestational age at delivery and survival to discharge did not differ between Stage I patients and those treated with placental laser ablation for more advanced stages of TTTS.
    MeSH term(s) Adult ; Birth Weight ; Disease Progression ; Female ; Fetofetal Transfusion/diagnostic imaging ; Fetofetal Transfusion/mortality ; Fetofetal Transfusion/pathology ; Gestational Age ; Humans ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies ; Severity of Illness Index ; Survival Rate ; Twins ; Ultrasonography
    Language English
    Publishing date 2010-07
    Publishing country England
    Document type Journal Article
    ZDB-ID 1073183-0
    ISSN 1469-0705 ; 0960-7692
    ISSN (online) 1469-0705
    ISSN 0960-7692
    DOI 10.1002/uog.7612
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  2. Article ; Online: Outcomes of laser surgery for stage I twin-twin transfusion syndrome.

    Gomez, Nicole G / Monson, Martha A / Chon, Andrew H / Korst, Lisa M / Llanes, Arlyn / Chmait, Ramen H

    Prenatal diagnosis

    2022  Volume 42, Issue 2, Page(s) 172–179

    Abstract: ... survival in expectantly managed stage I twin-twin transfusion syndrome (TTTS) patients and those undergoing ... the proportion of patients with at-least-one survivor in the single-center-laser cohort was 97.4%, with 88.6 ... to the RCT expectant management group.: Results: Of 126 consecutive stage I TTTS patients, 114 (90.5%) met ...

    Abstract Objective: A recent randomized controlled trial (RCT) demonstrated no difference in 6 month survival in expectantly managed stage I twin-twin transfusion syndrome (TTTS) patients and those undergoing immediate laser surgery. We aimed to describe outcomes following immediate laser surgery at a single fetal surgery center.
    Methods: A retrospective study of monochorionic diamniotic twins diagnosed with stage I TTTS who underwent laser surgery between 16 and 26 gestational weeks from 2006 to 2019. The primary outcome was 6 month survivorship. Intact survival was also assessed. Secondarily, outcomes were compared to the RCT expectant management group.
    Results: Of 126 consecutive stage I TTTS patients, 114 (90.5%) met inclusion criteria. Median (range) gestational age at delivery was 34.1 (20.6-39.4) weeks. At 6 months, the proportion of patients with at-least-one survivor in the single-center-laser cohort was 97.4%, with 88.6% dual survivorship. Neurological morbidity outcomes were available in 110 pregnancies (220 fetuses). Severe neurological morbidity occurred in 2.7% (6/220), and 6 month survival without severe neurological morbidity was 90.0%. Outcomes compared favorably with the RCT expectant management group.
    Conclusions: Given favorable survival and neurological outcomes, laser surgery is a reasonable treatment option for stage I TTTS at experienced fetal surgery centers. Further study is warranted to optimize treatment strategies.
    MeSH term(s) Adult ; Female ; Fetal Therapies/methods ; Fetofetal Transfusion/mortality ; Fetofetal Transfusion/surgery ; Humans ; Infant ; Infant, Newborn ; Laser Therapy/methods ; Male ; Pregnancy ; Retrospective Studies ; Survival Analysis ; Treatment Outcome ; Twins, Monozygotic
    Language English
    Publishing date 2022-01-20
    Publishing country England
    Document type Journal Article ; Observational Study
    ZDB-ID 82031-3
    ISSN 1097-0223 ; 0197-3851
    ISSN (online) 1097-0223
    ISSN 0197-3851
    DOI 10.1002/pd.6094
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  3. Article ; Online: Outcomes of laparoscopy-assisted fetoscopic laser photocoagulation for twin-twin transfusion syndrome: An established alternative for inaccessible anterior placenta.

    Krispin, Eyal / Nassr, Ahmed A / Espinoza, Jimmy / Donepudi, Roopali / Sun, Raphael C / Sanz-Cortes, Magda / Mostafaei, Shayan / Belfort, Michael A / Shamshirsaz, Alireza A

    Prenatal diagnosis

    2021  Volume 41, Issue 12, Page(s) 1582–1588

    Abstract: ... anastomoses in the treatment of twin-to-twin-transfusion syndrome (TTTS).: Study design: We performed ... affiliated tertiary medical-center. Outcomes were compared between patients who received laparoscopy-assisted ... FLPC (study group) and patients who underwent the conventional FLPC technique (control group). Baseline ...

    Abstract Objective: To evaluate laparoscopy-assisted fetoscopic laser photocoagulation (FLPC) of placental anastomoses in the treatment of twin-to-twin-transfusion syndrome (TTTS).
    Study design: We performed a retrospective cohort study analyzing pregnancies complicated by TTTS who underwent FLPC in a single university-affiliated tertiary medical-center. Outcomes were compared between patients who received laparoscopy-assisted FLPC (study group) and patients who underwent the conventional FLPC technique (control group). Baseline characteristics, sonographic findings, procedure details, and neonatal outcomes were compared between groups.
    Results: The cohort included 278 women with 31 in the study group and 247 in the control group. Sonographic parameters, including fetal biometry and TTTS stage, were comparable between study groups. Gestational age at delivery did not differ between the groups (29.22 ± 4.55 weeks in the study group vs. 30.62 ± 4.3 weeks in the control group, p = 0.09). There were no differences in neonatal survival rates at birth and at 30 days between both groups. A subanalysis comparing the laparoscopy-assisted group to only those patients with anterior placenta in the control group, showed a lower rate of incomplete Solomonization in the laparoscopy-assisted study group (3.4% vs. 33%, p = 0.01).
    Conclusion: Laparoscopy-assisted FLPC is a reasonable and safe option that may be offered in cases of FLPC where an anterior placenta restricts adequate surgical access.
    MeSH term(s) Adult ; Cohort Studies ; Female ; Fetofetal Transfusion/complications ; Fetofetal Transfusion/mortality ; Fetofetal Transfusion/surgery ; Fetoscopy/methods ; Fetoscopy/statistics & numerical data ; Humans ; Laparoscopy/methods ; Laparoscopy/standards ; Laparoscopy/statistics & numerical data ; Laser Coagulation/adverse effects ; Laser Coagulation/methods ; Laser Coagulation/statistics & numerical data ; Pregnancy ; Pregnancy Outcome/epidemiology ; Retrospective Studies ; Statistics, Nonparametric ; Ultrasonography, Prenatal/methods
    Language English
    Publishing date 2021-10-17
    Publishing country England
    Document type Journal Article
    ZDB-ID 82031-3
    ISSN 1097-0223 ; 0197-3851
    ISSN (online) 1097-0223
    ISSN 0197-3851
    DOI 10.1002/pd.5955
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  4. Article: Outcomes following selective fetoscopic laser ablation for twin-to-twin transfusion syndrome: a single-centre experience.

    Loh, Michelle / Bhatia, Anju / Tan, Kai Lit / Thia, Edwin / Yeo, George Seow Heong

    Singapore medical journal

    2019  Volume 61, Issue 10, Page(s) 523–531

    Abstract: ... for twin-to-twin transfusion syndrome (TTTS) in monochorionic twin pregnancies, is currently the treatment of choice at our centre ... surgery performance since then.: Methods: 15 consecutive patients who underwent FLP for Stage II-III ... and III TTTS respectively, with FLP performed at an earlier Quintero stage in the later cohort ...

    Abstract Introduction: Fetoscopic laser photocoagulation (FLP), a treatment option for twin-to-twin transfusion syndrome (TTTS) in monochorionic twin pregnancies, is currently the treatment of choice at our centre. We previously reported on our experience of FLP from June 2011 to March 2014. This paper audits our fetal surgery performance since then.
    Methods: 15 consecutive patients who underwent FLP for Stage II-III TTTS before 26 weeks of gestation from June 2011 to January 2017 were retrospectively reviewed, consisting of five cases from our initial experience and ten subsequent cases. Perioperative, perinatal and neonatal outcomes were analysed.
    Results: Of 15 pregnancies, 10 (66.7%) and 5 (33.3%) were for Stage II and III TTTS respectively, with FLP performed at an earlier Quintero stage in the later cohort. Overall mean gestational ages at presentation, laser and delivery were comparable between the cohorts at 19.7 (15.4-24.3) weeks, 20.3 (16.3-25.0) weeks and 31.2 (27.6-37.0) weeks, respectively. 2 (13.3%) cases had intra-amniotic bleeding and 1 (6.7%) had iatrogenic septostomy. 1 (6.7%) case had persistent TTTS requiring repeat FLP, and another (6.7%) had preterm premature rupture of membranes at seven weeks post procedure. The overall perinatal survival rate was 21 (75.0%) out of 28 infants. One mother underwent termination of pregnancy for social reasons at 1.4 weeks post procedure. Double survival occurred in 8 (57.1%) out of 14 pregnancies, while 13 (92.9%) had at least one survivor.
    Conclusion: FLP requires a highly specialised team and tertiary neonatal facility. Continual training improves maternal and perinatal outcomes, ensuring comparable standards with international centres.
    MeSH term(s) Female ; Fetofetal Transfusion/epidemiology ; Fetofetal Transfusion/surgery ; Gestational Age ; Humans ; Laser Therapy/methods ; Pregnancy ; Pregnancy, Twin ; Retrospective Studies ; Singapore/epidemiology ; Survival Rate
    Language English
    Publishing date 2019-09-06
    Publishing country Singapore
    Document type Journal Article ; Twin Study
    ZDB-ID 604319-7
    ISSN 0037-5675
    ISSN 0037-5675
    DOI 10.11622/smedj.2019107
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  5. Article ; Online: Distance Traveled to a Fetal Center and Pregnancy Outcomes in Twin-Twin Transfusion Syndrome.

    Bergh, Eric P / Donepudi, Roopali / Bell, Cynthia S / Moise, Kenneth J / Johnson, Anthony / Papanna, Ramesha

    Fetal diagnosis and therapy

    2019  Volume 47, Issue 6, Page(s) 451–456

    Abstract: ... for twin-twin transfusion syndrome (TTTS). Due to variability in geographic proximity to high-volume fetal centers, many patients ... cohort study of patients within the continental United States referred to our center between September 23, 2011 ... patient numbers and pregnancy outcomes assessed.: Results: A total of 393 patients met the inclusion ...

    Abstract Background: Fetoscopic laser photocoagulation (FLP) is the definitive treatment for twin-twin transfusion syndrome (TTTS). Due to variability in geographic proximity to high-volume fetal centers, many patients travel great distances to receive experienced care. We sought to determine whether distance traveled (DT) is associated with gestational age (GA) at delivery and neonatal survival.
    Methods: A prospective cohort study of patients within the continental United States referred to our center between September 23, 2011 and July 25, 2018 undergoing planned FLP for TTTS (n = 393; GA 20.6 ± 2.5 weeks; stage I: n = 50; stage II: n = 118; stage III: n = 208; stage IV: n = 17) was performed. The great-circle distance to our center was calculated using patients' home zip codes. DT was stratified into groups containing equal patient numbers and pregnancy outcomes assessed.
    Results: A total of 393 patients met the inclusion criteria. The threshold distance from our center was <250 miles (n = 181), 250-499 miles (n= 119), and ≥500 miles (n = 93). There was no significant difference between any of the preoperative variables among the three groups, with the exception of race and rural status. Furthermore, there was no significant association between DT and GA at delivery (p = 0.34), time interval from procedure to delivery (p = 0.37), and the number of neonatal survivors (p= 0.21). Preterm premature rupture of membranes (PPROM) at <34 weeks was highest (47.9%, p = 0.04) in the group traveling 250-499 miles.
    Conclusion: To our knowledge, this is the largest study to show that in TTTS, DT is not associated with GA at delivery, time interval from procedure to delivery, or neonatal survival. Although PPROM at <34 weeks was higher in the group traveling 250-499 miles, there was no significant difference in GA at delivery. While patients with advanced disease may choose to seek treatment based on proximity, traveling long distances does not adversely affect pregnancy outcomes.
    MeSH term(s) Adult ; Female ; Fetofetal Transfusion/surgery ; Fetoscopy ; Gestational Age ; Health Services Accessibility/statistics & numerical data ; Humans ; Infant, Newborn ; Laser Coagulation ; Pregnancy ; Pregnancy Outcome ; Pregnancy, Twin ; Prenatal Care ; Prospective Studies ; Travel/statistics & numerical data ; United States
    Language English
    Publishing date 2019-09-05
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 1066460-9
    ISSN 1421-9964 ; 1015-3837
    ISSN (online) 1421-9964
    ISSN 1015-3837
    DOI 10.1159/000501774
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  6. Article: Stage I Twin–Twin Transfusion Syndrome: Outcomes of Expectant Management and Prognostic Features

    Washburn, Erin E. / Sparks, Teresa N. / Gosnell, Kristen A. / Rand, Larry / Gonzalez, Juan M. / Feldstein, Vickie A.

    American Journal of Perinatology

    2018  Volume 35, Issue 14, Page(s) 1352–1357

    Abstract: Objective: This article describes the natural history of stage I twin–twin transfusion syndrome ... twin pregnancies from 2006 to 2016 with expectantly managed Quintero stage I TTTS.: Results: A total of 30 MCDA ... twin pregnancies with expectantly managed stage I TTTS were identified. Of these, eight (26.7%) progressed ...

    Abstract Objective: This article describes the natural history of stage I twin–twin transfusion syndrome (TTTS) including risk of progression to higher stage TTTS and pregnancy outcomes, and to identify risk factors for progression.
    Study Design: Retrospective cohort study of monochorionic diamniotic (MCDA) twin pregnancies from 2006 to 2016 with expectantly managed Quintero stage I TTTS.
    Results: A total of 30 MCDA twin pregnancies with expectantly managed stage I TTTS were identified. Of these, eight (26.7%) progressed to higher stage TTTS. Median gestational age (GA) at diagnosis for those that progressed was 18.9 ± 2.9 weeks versus 21.4 ± 3.4 weeks in those that remained stable ( p  = 0.06). Presence of an arterioarterial (A-A) anastomosis was assessed for 20/30 patients, and eight A-A were identified. Of those, 7/8 (87.5%) remained stable. In the complete cohort, a tiny or transiently visible bladder was noted in seven donor twins. Of these, 4/7 (57.1%) progressed. Excluding one termination, 47/58 (81.0%) fetuses survived.
    Conclusion: With expectant management of stage I TTTS, nearly three-fourths of pregnancies remain stable and most have survival of ≥ 1 twin. A-A anastomoses were not associated with progression to higher stage TTTS, whereas earlier GA at diagnosis or a small or intermittently visible donor bladder may herald greater risk of progression.
    Keywords twin–twin transfusion syndrome ; arterioarterial anastomosis ; natural history ; expectant management ; Quintero stage I
    Language English
    Publishing date 2018-02-08
    Publisher Thieme Medical Publishers
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 605671-4
    ISSN 1098-8785 ; 0735-1631
    ISSN (online) 1098-8785
    ISSN 0735-1631
    DOI 10.1055/s-0038-1627095
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  7. Article ; Online: Short and medium-term outcomes of live-born twins after fetoscopic laser therapy for twin-twin transfusion syndrome.

    Tosello, Barthélémy / Blanc, Julie / Haumonté, Jean-Baptiste / D'Ercole, Claude / Gire, Catherine

    Journal of perinatal medicine

    2014  Volume 42, Issue 1, Page(s) 99–105

    Abstract: ... pregnancies complicated by twin-twin transfusion syndrome treated by fetoscopic laser surgery.: Methods: This was ... a retrospective observational study performed between May 2007 and 2012. Neonatal data was from 45 patients under ... as a screening tool for neurologic outcome in children is original, which allowed in our cohort to highlight ...

    Abstract Objective: To evaluate short and medium term outcomes of children born of monochorionic pregnancies complicated by twin-twin transfusion syndrome treated by fetoscopic laser surgery.
    Methods: This was a retrospective observational study performed between May 2007 and 2012. Neonatal data was from 45 patients under 5 years of age. The prospective observational study was of the neurologic outcome of these children using the Ages and Stages Questionnaire (ASQ), 2nd edition, French version, at up to 5 years of age.
    Results: Neurologic assessment at discharge from maternity unit was normal for 41 infants (93.2%). Logistic regression suggested that the risk of neurosensory sequelae was significantly related to the status of donor [odds ratio=4.62 (1.18; 18.0)] and significantly preterm birth <32 weeks of gestation [odds ratio=5.50 (1.38; 21.9)]. Eleven questionnaires were considered abnormal (31.1%). Two children presented a severe neurologic abnormality (5.7%). There was no significant correlation between any area of the questionnaire and status at birth (donor or recipient).
    Conclusions: The data from our cohort, particularly as regards neurologic outcome, were satisfactory and concordant with previously published results. The use of the ASQ as a screening tool for neurologic outcome in children is original, which allowed in our cohort to highlight early neurological disorders.
    MeSH term(s) Adult ; Child, Preschool ; Developmental Disabilities/diagnosis ; Developmental Disabilities/etiology ; Female ; Fetofetal Transfusion/complications ; Fetofetal Transfusion/surgery ; Fetoscopy/methods ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Laser Coagulation/methods ; Linear Models ; Logistic Models ; Male ; Multivariate Analysis ; Nervous System Diseases/diagnosis ; Nervous System Diseases/etiology ; Pregnancy ; Prospective Studies ; Retrospective Studies ; Surveys and Questionnaires ; Treatment Outcome
    Language English
    Publishing date 2014-01
    Publishing country Germany
    Document type Evaluation Studies ; Journal Article ; Observational Study
    ZDB-ID 123512-6
    ISSN 1619-3997 ; 0300-5577 ; 0936-174X
    ISSN (online) 1619-3997
    ISSN 0300-5577 ; 0936-174X
    DOI 10.1515/jpm-2013-0119
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  8. Article ; Online: 'A problem shared is a problem halved': success of a statewide collaborative approach to fetal therapy. Outcomes of fetoscopic laser photocoagulation for twin-twin transfusion syndrome in Victoria.

    Teoh, Mark / Walker, Sue / Cole, Stephen / Edwards, Andrew

    The Australian & New Zealand journal of obstetrics & gynaecology

    2013  Volume 53, Issue 2, Page(s) 108–113

    Abstract: ... for twin-twin transfusion syndrome (TTTS).: Methods: The Victorian Fetal Therapy Service (VFTS) was developed in 2006. It is ... a prospective cohort study of VFTS patients referred for fetoscopic laser photocoagulation (FLP) for TTTS ... were included in this study. Overall survival was 67 of 98 (68%), and survival of ≥1 twin was seen ...

    Abstract Aims: To evaluate the performance of a collaborative fetal therapy service for treatment for twin-twin transfusion syndrome (TTTS).
    Methods: The Victorian Fetal Therapy Service (VFTS) was developed in 2006. It is a state-based three-centre collaborative service comprising a surgical team and clinical leadership group, designed to optimise access to, and performance of, fetoscopic procedures in Victoria. This is a prospective cohort study of VFTS patients referred for fetoscopic laser photocoagulation (FLP) for TTTS since 2006.
    Results: Forty-nine consecutive women with advanced (stage 2-4) TTTS between 2006 and 2011 were included in this study. Overall survival was 67 of 98 (68%), and survival of ≥1 twin was seen in 42 of 49 pregnancies (86%). There was no difference in survival by disease stage at diagnosis (≥1 survivor: 66% (stage 2 or 3 TTTS) vs 77% (stage 4 TTTS), P = 0.44), nor by surgical era (≥1 survivor: 60% (2006-2008) vs 74% of cases (2009-2011), P = 0.21). The median gestation gained post-FLP was 10.5 weeks.
    Conclusion: These results are consistent with published series and confirm the success of a novel service delivery model for fetal therapy in Victoria. We suggest that collaborative models such as ours should be considered for fetal conditions where treatment is complex and the total number of cases is small to ensure a consistent approach to assessment, management and follow-up of patients and to optimise training and research opportunities.
    MeSH term(s) Cooperative Behavior ; Delivery of Health Care/organization & administration ; Female ; Fetofetal Transfusion/surgery ; Gestational Age ; Government Programs/organization & administration ; Humans ; Laser Coagulation ; Pregnancy ; Pregnancy Outcome ; Prospective Studies ; Severity of Illness Index ; Survival Rate ; Victoria
    Language English
    Publishing date 2013-04
    Publishing country Australia
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 390815-x
    ISSN 1479-828X ; 0004-8666
    ISSN (online) 1479-828X
    ISSN 0004-8666
    DOI 10.1111/ajo.12062
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  9. Article ; Online: Stage based recipient and donor outcome in twin-to-twin transfusion syndrome treated by fetoscopic laser surgery using Solomon technique.

    Kyvernitakis, I / Rosner, M / Birk, A / Goodman, L / Herlands, L / Wohlmuth, P / Laurie, M / Millard, S / Kush, M / Miller, J / Baschat, A A

    Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology

    2024  

    Abstract: ... with twin-to-twin transfusion syndrome (TTTS) after Solomon laser treatment.: Methods: Single center cohort of consecutive ... Objective: To evaluate twin survival stratified by Quintero stage in patients ... stage III and 27 (6.7%) stage IV. Post laser TAPS or recurrent TTTS occurred in 19 (4.7%) patients and ...

    Abstract Objective: To evaluate twin survival stratified by Quintero stage in patients with twin-to-twin transfusion syndrome (TTTS) after Solomon laser treatment.
    Methods: Single center cohort of consecutive twin pregnancies treated with Solomon laser for TTTS. Preoperative Quintero stage, perioperative characteristics and obstetric factors were related to neonatal survival of the recipient and donor at discharge. Determinants of twin survival were evaluated using univariate, logistic regression and cumulative survival probability analyses.
    Results: Of 402 twins with TTTS, 80 (19.9%) had stage I, 126 (31.3%) stage II, 169 (42%) stage III and 27 (6.7%) stage IV. Post laser TAPS or recurrent TTTS occurred in 19 (4.7%) patients and 11 (2.7%) required repeat laser. Preterm premature rupture of membranes occurred in 150 (37.3%) patients and median gestational age of delivery 32+1 weeks. In 303 (75.4%) both twins were alive at discharge; [66 (82.5%) in stage I, 101 (80.2%) in stage II, 114 (67.5%) in stage III and 22 (81.5%) in stage IV, p=0.062]. Compared to recipients, donor survival was only lower in stage III (155 (91.7%) recipients vs 118 (69.8%) donors, Chi square 24.685, p<0.0001). Larger intertwin size discordance and umbilical artery (UA) end-diastolic velocity (EDV) determined donor demise (Nagelkerke R
    Conclusion: Solomon laser achieves TTTS resolution and double survival in a high proportion of cases. Recipient and donor survival is comparable unless there is significant size discordance and placental dysfunction. This degree of unequal placental sharing, typically found in stage III, is the primary factor preventing double survival due to a higher rate of donor demise. This article is protected by copyright. All rights reserved.
    Language English
    Publishing date 2024-02-21
    Publishing country England
    Document type Journal Article
    ZDB-ID 1073183-0
    ISSN 1469-0705 ; 0960-7692
    ISSN (online) 1469-0705
    ISSN 0960-7692
    DOI 10.1002/uog.27620
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  10. Article ; Online: Outcome after fetoscopic selective laser ablation of placental anastomoses vs equatorial laser dichorionization for the treatment of twin-to-twin transfusion syndrome.

    Baschat, Ahmet Alexander / Barber, James / Pedersen, Nicole / Turan, Ozhan M / Harman, Chris R

    American journal of obstetrics and gynecology

    2013  Volume 209, Issue 3, Page(s) 234.e1–8

    Abstract: ... with twin-twin transfusion syndrome (TTTS) who were managed by selective laser ablation of placental anastomoses (S-LASER) vs ... twin pregnancies had laser (S-LASER, n = 71; ED-LASER, n = 76). Obstetric history, Quintero stage, placental ... lower recurrence of TTTS (3.9% vs 8.5%), twin anemia polycythemia sequence (2.6% vs 4.2%), and ...

    Abstract Objective: The objective of the study was to compare the outcome in women with twin-twin transfusion syndrome (TTTS) who were managed by selective laser ablation of placental anastomoses (S-LASER) vs equatorial dichorionization of the anastomoses and chorionic plate (ED-LASER).
    Study design: We conducted an analysis of 2 consecutive cohorts with TTTS treated with S-LASER and ED-LASER. Preoperative, procedural, delivery, and outcome details were compared between treatment groups.
    Results: A total of 147 twin pregnancies had laser (S-LASER, n = 71; ED-LASER, n = 76). Obstetric history, Quintero stage, placental location, individual arterial and venous Doppler parameters, and gestational age at laser and delivery did not differ. Use of lens fetoscope (96.1% vs 50.7%), coagulated anastomosis count (11 vs 15, P < .001), complete equatorial plate visualization (77.5% vs 92.1%, P = .019), and amniotic fluid transparency (80.3% vs 94.7%, P = .011) was greater during ED-LASER. Procedure-related complications, gestational age at delivery, and perinatal details were comparable between groups. ED-LASER was associated with significantly lower recurrence of TTTS (3.9% vs 8.5%), twin anemia polycythemia sequence (2.6% vs 4.2%), and amniotic fluid abnormalities (0% vs 5.6%, P < .05 for all comparisons). Logistic regression identified complete visualization of the equator as the primary determinant for successful TTTS treatment and coagulation of the chorionic plate as an independent cofactor. Double survival at age 6 months was significantly higher after ED-LASER (68.4% vs 50.7%, P < .05), attributable to a lower postlaser and neonatal mortality rates.
    Conclusion: In patients with TTTS, photocoagulation of causative anastomoses and the chorionic plate along the vascular equator decreases recurrence without increasing adverse outcome and improves survival compared with the selective technique.
    MeSH term(s) Adolescent ; Adult ; Arteriovenous Anastomosis/surgery ; Female ; Fetofetal Transfusion/surgery ; Fetoscopy ; Humans ; Laser Coagulation ; Laser Therapy ; Logistic Models ; Middle Aged ; Placenta/blood supply ; Pregnancy ; Retrospective Studies
    Language English
    Publishing date 2013-09
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 80016-8
    ISSN 1097-6868 ; 0002-9378
    ISSN (online) 1097-6868
    ISSN 0002-9378
    DOI 10.1016/j.ajog.2013.05.034
    Database MEDical Literature Analysis and Retrieval System OnLINE

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