Fetoscopic laser therapy for twin-twin transfusion syndrome before 17 and after 26 weeks' gestation.

OBJECTIVE The purpose of this study was to compare perinatal outcomes of pregnancies that undergo "early" (<17 weeks' gestation) or "late" (>26 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 <7 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 <17 or >26 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.

[1]  E. Lopriore,et al.  Twin‐to‐twin transfusion syndrome after 26 weeks of gestation: is there a role for fetoscopic laser surgery? , 2007, BJOG : an international journal of obstetrics and gynaecology.

[2]  Roberto Romero,et al.  Epidemiology and causes of preterm birth , 2008, The Lancet.

[3]  J. Deprest,et al.  Minimally invasive fetal therapy. , 2012, Best practice & research. Clinical obstetrics & gynaecology.

[4]  S. Evans,et al.  The progression of disease stage in twin-twin transfusion syndrome. , 2004, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[5]  N. Fisk,et al.  The basic and clinical science of twin-twin transfusion syndrome. , 2009, Placenta.

[6]  Jan Deprest,et al.  Fetoscopic Laser Surgery for Twin-to-Twin Transfusion Syndrome after 26 Weeks of Gestation , 2011, Fetal Diagnosis and Therapy.

[7]  N. Iacovidou,et al.  Neonatal outcome of preterm delivery , 2010, Annals of the New York Academy of Sciences.

[8]  Yvonne W. Cheng,et al.  Factors and outcomes associated with longer latency in preterm premature rupture of membranes , 2008, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[9]  Vincenzo D'Addario,et al.  Laser therapy and serial amnioreduction as treatment for twin-twin transfusion syndrome: a metaanalysis and review of literature. , 2008, American journal of obstetrics and gynecology.

[10]  M. A. Melo,et al.  Limb Constriction Secondary to Pseudoamniotic Band Syndrome after Selective Fetoscopic Laser Surgery: Report of a Case with a Favorable Outcome , 2012, Fetal Diagnosis and Therapy.

[11]  Russell S. Miller,et al.  Twin-twin transfusion syndrome. , 2012, Seminars in perinatology.

[12]  J. Deprest,et al.  Current experience with fetoscopy and the Eurofoetus registry for fetoscopic procedures. , 2000, European journal of obstetrics, gynecology, and reproductive biology.

[13]  F. Walther,et al.  Neonatal morbidity in twin-twin transfusion syndrome. , 2011, Early human development.

[14]  N. Fisk,et al.  Perinatal morbidity and mortality rates in severe twin-twin transfusion syndrome: results of the International Amnioreduction Registry. , 2001, American journal of obstetrics and gynecology.

[15]  T. Hara,et al.  Prognosis and long-term neurodevelopmental outcome in conservatively treated twin-to-twin transfusion syndrome , 2011, BMC pregnancy and childbirth.

[16]  Jan Deprest,et al.  The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy: a prospective cohort study. , 2008, American journal of obstetrics and gynecology.

[17]  D. Murphy,et al.  Neonatal risk factors for cerebral palsy in very preterm babies: case-control study , 1997, BMJ.

[18]  W. McGuire,et al.  Neurodevelopmental outcomes after preterm birth , 2004, BMJ : British Medical Journal.

[19]  F. Walther,et al.  Long-term neurodevelopmental outcome in monochorionic twins after fetal therapy. , 2011, Early human development.

[20]  R. Quintero,et al.  Staging of Twin-Twin Transfusion Syndrome , 1999, Journal of Perinatology.

[21]  B. McCrindle,et al.  Impact of selective laser ablation of placental anastomoses on the cardiovascular pathology of the recipient twin in severe twin-twin transfusion syndrome. , 2006, American journal of obstetrics and gynecology.

[22]  P. Lewi,et al.  Assessment of fetal cardiac function before and after therapy for twin-to-twin transfusion syndrome. , 2009, American journal of obstetrics and gynecology.

[23]  P. Lewi,et al.  The role of ultrasound examination in the first trimester and at 16 weeks' gestation to predict fetal complications in monochorionic diamniotic twin pregnancies. , 2008, American journal of obstetrics and gynecology.

[24]  N. Okun,et al.  Randomised trial to assess safety and fetal outcome of early and midtrimester amniocentesis , 1998, The Lancet.

[25]  P. P. Berg,et al.  Neurologic and Developmental Disability at Six Years of Age After Extremely Preterm Birth , 2006 .

[26]  Jan Deprest,et al.  Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. , 2004, The New England journal of medicine.

[27]  P. Tsay,et al.  Prognostic factors and clinical features in liveborn neonates with hydrops fetalis. , 2007, American journal of perinatology.

[28]  V. D’addario,et al.  Comparison of donor and recipient outcomes following laser therapy performed for twin-twin transfusion syndrome: a meta-analysis and review of literature. , 2009, American journal of perinatology.

[29]  Jan Deprest,et al.  Monochorionic Diamniotic Twin Pregnancies: Natural History and Risk Stratification , 2010, Fetal Diagnosis and Therapy.

[30]  D. Wing,et al.  Twin versus singleton pregnancies complicated by preterm premature rupture of membranes , 2012, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.