Fetoscopic laser surgery in 100 pregnancies with severe twin-to-twin transfusion syndrome in the Netherlands.
OBJECTIVE
In this prospective cohort study, we evaluated the initial results of fetoscopic laser surgery for severe second trimester twin-to-twin transfusion syndrome (TTTS) treated at our centre.


METHODS
A total of 100 consecutive pregnancies with severe second trimester TTTS treated at our centre with selective fetoscopic laser coagulation of vascular anastomoses on the placental surface between August 2000 and November 2004 were included in the study. Perinatal survival was analysed in relation to Quintero stage.


RESULTS
Median gestational age was 20 weeks at fetoscopy (range: 16-26) and 33 weeks at delivery (range: 18-40). Perinatal survival rate was 70% (139/200). The treatment resulted in at least one survivor at the age of 4 weeks in 81% of pregnancies. Perinatal survival was significantly higher when treatment was performed in the early Quintero stages (95% in stage 1, 76% in stage 2, 70% in stage 3, 50% in stage 4) (p = 0.02).


CONCLUSIONS
Results of fetoscopic laser surgery for TTTS in our centre are similar to those in specialised centres in other countries. Diagnosis and treatment in the early Quintero stages resulted in significantly higher perinatal survival.
Middeldorp
J M
JM
Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands. j.m.middeldorp@lumc.nl
Sueters
M
M
Lopriore
E
E
Klumper
F J C M
FJ
Oepkes
D
D
Devlieger
R
R
Kanhai
H H H
HH
Vandenbussche
F P H A
FP
D005260:Female; D046128:Fetal Therapies / Q000379:methods*; D005330:Fetofetal Transfusion / Q000401:mortality / Q000601:surgery*; D005332:Fetoscopy / Q000379:methods; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D053685:Laser Therapy / Q000379:methods*; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D016896:Treatment Outcome