+ Site Statistics
References:
54,258,434
Abstracts:
29,560,870
PMIDs:
28,072,757
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Outcome after fetoscopic selective laser ablation of placental anastomoses vs equatorial laser dichorionization for the treatment of twin-to-twin transfusion syndrome



Outcome after fetoscopic selective laser ablation of placental anastomoses vs equatorial laser dichorionization for the treatment of twin-to-twin transfusion syndrome



American Journal of Obstetrics and Gynecology 209(3): 234.E1-8



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). 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. 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. 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.

(PDF emailed within 0-6 h: $19.90)

Accession: 054806786

Download citation: RISBibTeXText

PMID: 23707807

DOI: 10.1016/j.ajog.2013.05.034


Related references

Outcome after fetoscopic selective laser ablation of placental anastomoses versus equatorial laser dichorionization for the treatment of Twin-to-Twin Transfusion Syndrome. 2013

Selective fetoscopic laser photocoagulation of superficial placental anastomoses for the treatment of severe twin-twin transfusion syndrome. Clinics 64(2): 91-96, 2009

Fetoscopic laser ablation of the placental anastomoses in twin-twin transfusion syndrome using the “Solomon technique. 2013

Fetoscopic laser ablation of placental anastomoses in twin-twin transfusion syndrome using 'Solomon technique'. Ultrasound in Obstetrics and Gynecology 42(4): 434-439, 2014

Elevated cell-free fetal DNA in maternal plasma after fetoscopic laser ablation of placental vascular anastomoses in twin-twin transfusion syndrome. American Journal of Obstetrics & Gynecology 189(6 Supplement): S219, 2003

Fetal cardiac function in recipient twins undergoing fetoscopic laser ablation of placental anastomoses for Stage IV twin-twin transfusion syndrome. Ultrasound in Obstetrics and Gynecology 42(1): 64-69, 2014

Pseudoamniotic Band Syndrome After Fetoscopic Laser Ablation of Placental Anastomoses for Twin-Twin Transfusion Syndrome: Two Case Reports and Systematic Review. Journal of Ultrasound in Medicine 36(11): 2373-2377, 2017

Fetal Cardiac Function In Recipient Twins Undergoing Fetoscopic Laser Ablation Of Placental Anastomoses For Stage Iv Twin-Twin Transfusion Syndrome TTTS. Ultrasound in Obstetrics & Gynecology 42(1): n/a-n/a, 2013

Impact of selective laser ablation of placental anastomoses on the cardiovascular pathology of the recipient twin in severe twin-twin transfusion syndrome. American Journal of Obstetrics and Gynecology 195(5): 1388-1395, 2006

Severe twin-twin transfusion syndrome: outcome after fetoscopic laser ablation of the placental vascular equator. Bjog 114(6): 689-693, 2007

Isolated Ascites in a Monochorionic Twin after Fetoscopic Laser Ablation Is Not Necessarily Secondary to Recurrence or Anaemia: Bowel Complications in Twin-to-Twin Transfusion Syndrome after Fetoscopic Laser Ablation. Fetal Diagnosis and Therapy 2018: 1-10, 2018

Sono-endoscopic delineation of the placental vascular equator prior to selective fetoscopic laser ablation in twin-to-twin transfusion syndrome. Ultrasound in Obstetrics and Gynecology 16(3): 226-229, 2001

Selective laser ablation of placental vascular anastomoses in severe twin to twin transfusion syndrome. American Journal of Obstetrics & Gynecology 187(6 Supplement): S188, 2002

Outcome following selective fetoscopic laser ablation for twin to twin transfusion syndrome: an 8 year national collaborative experience. European Journal of Obstetrics, Gynecology, and Reproductive Biology 191: 125-129, 2016

Laser ablation of the placental vascular anastomoses for the treatment of twin-to-twin transfusion syndrome. Revista de Investigacion Clinica; Organo del Hospital de Enfermedades de la Nutricion 63(1): 46-52, 2011