Neonatal outcome in twin-to-twin transfusion syndrome treated with fetoscopic laser occlusion of vascular anastomoses.
OBJECTIVE
To determine neonatal mortality and morbidity rates in monochorionic twins with chronic twin-to-twin transfusion syndrome (TTTS) treated with fetoscopic laser occlusion of vascular anastomoses.


METHODS
In a prospective study of monochorionic twins delivered at our center between June 2002 and December 2004, neonatal outcome was assessed in 40 monochorionic twin pairs with TTTS treated with laser compared with 46 monochorionic twin pairs without TTTS.


RESULTS
The neonatal mortality rate in the TTTS and no-TTTS group was 8% (6/76) and 3% (3/90), respectively. The rate of severe cerebral lesions on ultrasound scanning in the TTTS and no-TTTS group was 14% (10/72) and 6% (5/82), respectively. The incidence of adverse neonatal outcome (neonatal death, major neonatal morbidity, or severe cerebral lesions) in the TTTS and no-TTTS group was, respectively, 26% (20/76) and 13% (12/90) (RR = 1.97, 95% CI = 1.03 to 3.77).


CONCLUSIONS
Although perinatal outcome in TTTS has improved after laser therapy, neonatal mortality and morbidity rates remain high. Relative risk for adverse neonatal outcome is increased 2-fold in TTTS treated with laser relative to monochorionic twins without TTTS.
Lopriore
Enrico
E
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands. e.lopriore@lumc.nl
Sueters
Marieke
M
Middeldorp
Johanna M
JM
Oepkes
Dick
D
Vandenbussche
Frank P
FP
Walther
Frans J
FJ
D016022:Case-Control Studies; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D005260:Female; D005330:Fetofetal Transfusion / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D017075:Laser Coagulation; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D011247:Pregnancy; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome