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Fetoscopic laser ablation of the placental anastomoses in twin-twin transfusion syndrome using the “Solomon technique



Fetoscopic laser ablation of the placental anastomoses in twin-twin transfusion syndrome using the “Solomon technique







To document perinatal outcomes following the Solomon technique in the selective photocoagulation of placental anastomoses for severe twin-twin transfusion syndrome (S). Between January 2010 and July 2012, data were collected from 102 consecutive monochorionic twin pregnancies complicated by severe S that underwent fetoscopic laser ablation. We compared outcomes between subjects who underwent selective laser coagulation with the Solomon technique (cases) versus those who had selective laser coagulation without this procedure (controls). Of the 102 cases examined, 26 (25%) had the Solomon technique and 76 (75%) did not. Of the 204 newborns, 139 (68.1%) survived up to 30 days of life. 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 two twins (84.6% vs. 46.1%, p<0.01) and a higher overall neonatal survival rate (45/52 (86.5%) vs. 94/152 (61.8%), p<0.01). The Solomon technique remained independently associated with dual twin surviving (aOR, 11.35, 95% CI=3.11-53.14, p=0.0007) and overall neonatal survival rate (aOR=4.65; 95% CI=1.59-13.62, p=0.005) after multivariate analysis. There were no cases of recurrent S or twin anemia-polycythemia sequence (TAPS) in the Solomon technique group. The use of Solomon technique following selective laser coagulation of placental anastomoses appears to improve twin survival, and may reduce the risk of recurrent S and TAPS.

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Accession: 036865025

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DOI: 10.1002/uog.12492


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