Neonatal outcome in preterm monochorionic twins with twin-to-twin transfusion syndrome after intrauterine treatment with amnioreduction or fetoscopic laser surgery: comparison with dichorionic twins.
OBJECTIVE
The purpose of this study was to compare neonatal outcome in preterm neonates after twin-to-twin transfusion syndrome (TTTS) that was treated by amnioreduction or fetoscopic laser surgery (FLS) and in dichorionic neonates who were matched for gestational age at birth.


METHODS
Neonatal outcome was assessed in 137 TTTS preterm neonates who were treated primarily with either amnioreduction (n = 36) or FLS (n = 101) and compared with dichorionic twins (n = 242) who were delivered at our center at 24-34 weeks of gestation.


RESULTS
Adverse neonatal outcome (death or severe cerebral lesions) was more frequent in the amnioreduction group than in the FLS and dichorionic groups. Overall neonatal outcome was comparable in FLS and dichorionic infants. However, neonatal morbidity was higher in FLS neonates at <30 weeks of gestation that was related mainly to failed laser therapy.


CONCLUSIONS
In preterm TTTS cases, neonatal morbidity decreases independently with gestational age and after successful FLS. Neonatal morbidity that was specific of TTTS was higher in the amnioreduction group and in cases with failed laser therapy.
Lenclen
Richard
R
Department of Neonatology, Paris-Ouest University, CHI Poissy-St-Germain, France. rlenclen@chi-psg.com
Paupe
Alain
A
Ciarlo
Giuseppina
G
Couderc
Sophie
S
Castela
Florence
F
Ortqvist
Lisa
L
Ville
Yves
Y
D000649:Amniocentesis; D002823:Chorion; D005260:Female; D005330:Fetofetal Transfusion / Q000401:mortality / Q000601:surgery*; D005332:Fetoscopy; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D053685:Laser Therapy; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000401:mortality; D012189:Retrospective Studies