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Outcome after fetoscopic selective laser ablation of placental anastomoses versus equatorial laser dichorionization for the treatment of Twin-to-Twin Transfusion Syndrome



Outcome after fetoscopic selective laser ablation of placental anastomoses versus equatorial laser dichorionization for the treatment of Twin-to-Twin Transfusion Syndrome







To compare outcome in women with twin twin transfusion syndrome (S) that were managed by selective laser ablation of placental anastomoses (S-LASER) versus equatorial dichorionization of the anastomoses and chorionic plate (ED-LASER). Analysis of two consecutive cohorts with S treated with S-LASER and ED-LASER. Pre-operative, procedural, delivery and outcome details were compared between treatment groups. 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, gestational age at laser delivery did not differ. Use of lens fetoscope (96.1% vs. 50.7%), coagulated anastomosis count (11 vs. 15, p<0.001), complete equatorial plate visualization (77.5% vs. 92.1%, p=0.019) and amniotic fluid transparency (80.3% vs. 94.7%, p=0.011) 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 S (3.9% vs. 8.5%), TAPS (2.6% vs. 4.2%) and amniotic fluid abnormalities (0% vs. 5.6%, p<0.05 for all comparisons). Logistic regression identified complete visualization of the equator as the primary determinant for successful S 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<0.05), attributable to a lower post-laser and neonatal mortality rates. In patients with S photocoagulation of causative anastomoses and the chorionic plate along the vascular equator decreases recurrence without increasing adverse outcome and improves survival compared to the selective technique.

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