Recent findings on laser treatment of twin-to-twin transfusion syndrome.
OBJECTIVE
Despite the recent demonstration of the benefit of the primary laser over amnioreduction, overall survival is far from optimal (70-80%), and therefore diagnosis and management of early and late complications following placental surgery became of great importance.


RESULTS
Laser therapy has proven to be better than amnioreduction in treating twin-to-twin transfusion syndrome. Miscarriage, preterm premature rupture of the membranes and preterm delivery account for more than 20% of perinatal mortality after treatment. In those who die despite treatment, recurrence of twin-to-twin transfusion syndrome, placental insufficiency or feto-fetal hemorrhage with anemia/polycythemia are complications that have to be managed with different secondary therapeutic options, such as amnioreduction, cord coagulation, intrauterine transfusion or repeat fetoscopy-guided laser. Ex-vivo placental angiography has confirmed that these complications occur when anastomoses are missed. Early predictors of laser efficacy in twin-to-twin transfusion syndrome treatment, such as improvement in the umbilical vein flow imbalance and urine production, are being evaluated, because they are earlier predictors of outcome than amniotic fluid discordance.


CONCLUSIONS
Optimization of laser treatment of twin-to-twin transfusion syndrome and new insight into the follow-up are likely to become the key to a better prognosis, and they are therefore important issues that have to be addressed in forthcoming studies.
Yamamoto
Masami
M
Unidad de Medicina Perinatal, Clínica Alemana, Hospital Padre Hurtado, Universidad del Desarrollo, Santiago, Chile.
Ville
Yves
Y
D005260:Female; D005330:Fetofetal Transfusion / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D017075:Laser Coagulation / Q000009:adverse effects / Q000379:methods*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D014427:Twins; D016216:Ultrasonography, Prenatal