Stage-related outcome in twin-twin transfusion syndrome treated by fetoscopic laser coagulation.
OBJECTIVE
To assess perinatal outcome in monochorionic twin pregnancies according to different stages of severe mid-trimester twin-twin transfusion syndrome managed by fetoscopic laser coagulation of the placental vascular anastomoses.


METHODS
In a prospective study fetoscopic laser therapy was performed in 200 consecutive pregnancies with severe mid-trimester twin-twin transfusion syndrome at a median gestational age of 20.7 weeks (range 15.9-25.3 weeks). Outcome data were analyzed for the whole group and separately for each stage according to the Quintero staging system.


RESULTS
The overall survival rate was 71.5% (286/400), with survival of both twins in 59.5% (119/200) and survival of at least one of the twins in 83.5% (167/200). The median gestational age at delivery of liveborn neonates was 34.3 weeks (range 23.1-40.4 weeks). There was a significant trend toward reduced survival rates with increasing stage (P=.038). The percentage of pregnancies with survival of both fetuses was 75.9% (22/29) for stage I, 60.5% (49/81) for stage II, 53.8% (43/80) for stage III, and 50% (5/10) for stage IV. At least one of the twins survived in 93.1% (27/29) at stage I, 82.7% (67/81) at stage II, 82.5% (66/80) at stage III, and 70% (7/10) at stage IV. The overall survival rate for donor fetuses was 70.5% (141/200) and for recipient fetuses, 72.5% (145/200).


CONCLUSIONS
These data show that laser therapy is an effective therapeutic option for all stages of severe twin-twin transfusion syndrome and provide information to counsel patients according to the stage of the syndrome.
Huber
Agnes
A
Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, UKE, Hamburg, Germany.
Diehl
Werner
W
Bregenzer
Thomas
T
Hackelöer
Bernd-Joachim
BJ
Hecher
Kurt
K
D001163:Arteriovenous Anastomosis / Q000473:pathology / Q000601:surgery; D005260:Female; D005313:Fetal Death; D005330:Fetofetal Transfusion / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005332:Fetoscopy; D005858:Germany; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D017075:Laser Coagulation; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D014427:Twins