Fetofetal transfusion syndrome in triplet pregnancies: outcome after endoscopic laser surgery.
OBJECTIVE
The purpose of this study was to determine the outcome of fetofetal transfusion syndrome in triplet pregnancies after treatment with endoscopic laser ablation of communicating placental vessels.


METHODS
Cases of severe fetofetal transfusion syndrome that occur in triplet pregnancies and that are treated with endoscopic laser ablation of placental anastomosis were identified from a prospectively collected fetal medicine database. Chorionicity was determined by sonography and classified as dichorionic or monochorionic. Perinatal outcome was obtained in all cases, and long-term follow-up was obtained in all pregnancies that resulted in at least 1 survivor.


RESULTS
During a 6-year period, 10 cases of severe fetofetal transfusion syndrome that were treated with endoscopic laser ablation were identified, of which 7 cases were dichorionic and 3 cases were monochorionic. At least 1 fetus survived in all 7 dichorionic pregnancies and in 2 of the 3 monochorionic pregnancies. In the dichorionic pregnancies, 14 of 21 fetuses (66.7%) survived, but in the monochorionic pregnancies only 2 of 9 fetuses (22.2%) survived.


CONCLUSIONS
Endoscopic laser ablation is feasible in triplet pregnancies that are complicated by severe fetofetal transfusion syndrome. The treatment appears to be associated with improved perinatal outcome in dichorionic, but not in monochorionic, triplets, probably because of the technical inability in achieving ablation of all the communicating vessels in monochorionic triplets.
Sepulveda
Waldo
W
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical School, London, United Kingdom.
Surerus
Erika
E
Vandecruys
Hilde
H
Nicolaides
Kypros H
KH
D016208:Databases, Factual; D004724:Endoscopy / Q000379:methods / Q000706:statistics & numerical data; D004739:England / Q000453:epidemiology; D005260:Female; D005330:Fetofetal Transfusion / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D053685:Laser Therapy / Q000379:methods / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D016896:Treatment Outcome; D014310:Triplets