title: Twin-to-twin transfusion syndrome after 26 weeks of gestation: is there a role for fetoscopic laser surgery?
abstract: OBJECTIVE
  To compare fetoscopic laser surgery with amniodrainage in the treatment of twin-to-twin transfusion syndrome (TTTS) diagnosed after 26 weeks of gestation.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  Leiden University Medical Centre, a tertiary referral hospital for fetal therapy.
  
  
  METHODS
  Between January 1991 and February 2006, 21 TTTS cases were diagnosed and treated after 26 weeks of gestation.
  
  
  METHODS
  Treatment of TTTS consisted of either amniodrainage or fetoscopic laser coagulation of vascular anastomoses.
  
  
  METHODS
  
  
  
  METHODS
  adverse outcome (intrauterine or neonatal death, major neonatal morbidity and/or severe cerebral injury). Secondary outcome: gestational age at birth.
  
  
  RESULTS
  Eleven TTTS cases were treated with amniodrainage and ten with laser surgery. Median gestational age at birth in the amniodrainage group and in the laser surgery group was 29 and 31 weeks, respectively (P = 0.17) All infants were born alive. Major neonatal morbidity occurred more often in the amniodrainage group than in the laser surgery group, 27% (6/22) and 0% (0/20), respectively (P = 0.02). Severe cerebral injury in the amniodrainage group and in the laser surgery group occurred in 23% (5/22) and 15% (3/20) of infants, respectively (P = 0.70). Neonatal mortality in the amniodrainage group and in the laser surgery group was 14% (3/22) and 0% (0/20), respectively (P = 0.23). Overall adverse outcome was 36% (8/22) in the amniodrainage group and 15% (3/20) in the laser surgery group (P = 0.17).
  
  
  CONCLUSIONS
  In TTTS diagnosed after 26 weeks of gestation, amniodrainage and laser surgery both result in 100% survival. However, infants born after laser surgery have less major neonatal morbidity.
authors.affiliation: Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands. j.m.middeldorp@lumc.nl
authors.forename: J M
authors.initials: JM
authors.lastname: Middeldorp
authors.forename: E
authors.initials: E
authors.lastname: Lopriore
authors.forename: M
authors.initials: M
authors.lastname: Sueters
authors.forename: F J C M
authors.initials: FJ
authors.lastname: Klumper
authors.forename: H H H
authors.initials: HH
authors.lastname: Kanhai
authors.forename: F P H A
authors.initials: FP
authors.lastname: Vandenbussche
authors.forename: D
authors.initials: D
authors.lastname: Oepkes
mesh_terms: D000328:Adult; D000650:Amnion / Q000601:surgery*; D015331:Cohort Studies; D004322:Drainage / Q000379:methods*; D005260:Female; D005330:Fetofetal Transfusion / Q000601:surgery*; D005332:Fetoscopy / Q000379:methods*; D005865:Gestational Age; D006801:Humans; D007223:Infant; D017075:Laser Coagulation / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies