Timing of delivery following selective laser photocoagulation for twin-to-twin transfusion syndrome
We sought to compare intrauterine risks with postnatal outcome in monochorionic pregnancies operated by fetoscopic laser surgery for twin-to-twin transfusion syndrome. A cohort of 602 consecutive cases was analyzed. Unexpected prenatal adverse events were identified when a fatal or potentially fatal event occurred that could have been avoided by timely delivery. The prospective risk of an unexpected adverse event dropped from 16.8% (95% confidence interval [CI], 13.6-20.5%) to 0% (95% CI, 0-11%) between 26-36 weeks. At 32 weeks, the residual risk was 1 in 17 (95% CI, 1/28-1/11). The perinatal rate of death or severe brain lesions dropped from 35% (25-47%) in infants delivered at 26-28 weeks down to 3% (1-6%) at 34-36 weeks. Our results did not identify an optimal cut-off for elective preterm delivery in laser-operated twin-to-twin transfusion syndrome. Perinatal morbidity appears low from ≥32 weeks and the decision for elective delivery should be based upon medical history, parental demand, and expert assessment.
[Show abstract] [Hide abstract] ABSTRACT: 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. 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. 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. 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. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.0Comments 2Citations
- "In keeping with previous reports, a total of 84.7% of cases overall were delivered before 34 weeks' gestation, with the majority of cases delivered electively . We report a PPROM rate of 10% within a four week interval from the time of the fetoscopic procedure, which is comparable to published figures  . "
- [Show abstract] [Hide abstract] ABSTRACT: Methods The transplacental treatment of fetal tachyarrhythmia and intrauterine erythrocyte transfusion for fetal anemia have been successfully performed for more than 30 years. Minimally invasive fetal interventions can be performed under (1) sonographic guidance as pleuroamniotic shunt for hydrothorax or vesico-amniotic shunt for urethral obstruction and as cardiac interventions (e.g. balloon valvuloplasty, atrioseptoplasty and stenting) or (2) fetoscopically guided as laser coagulation of chorionic plate vessels for twin-twin transfusion syndrome and balloon occlusion of the trachea for severe diaphragmatic hernia. Results Correct selection of fetuses which profit from the intervention, great experience and training of the practitioners, multidisciplinary counselling and perinatal management are some important steps for the success of fetal treatment procedures. Conclusion Restriction of these complex interventions to a few centers allows technical and structural competence to be achieved and the acquisition of more knowledge by participating in multicenter studies.0Comments 0Citations
- [Show abstract] [Hide abstract] ABSTRACT: Congenital birth defects and early/premature birth are common complex conditions affecting populations throughout the world, the interaction of which accounts for a significant proportion of neonatal morbidity and mortality. The relationship between these two conditions is not well understood. Several congenital birth defects can directly lead to early delivery. In addition, certain fetal conditions may necessitate early or premature delivery, several of which are also associated with maternal conditions necessitating early birth. Further understanding of both the incidences and causes of congenital birth defects and of early and premature birth will facilitate establishment of strategies to improve neonatal mortality and morbidity.0Comments 0Citations