title: A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome.
abstract: OBJECTIVE
  The objective of the study was to examine the effect of selective fetoscopic laser photocoagulation (SFLP) vs serial amnioreduction (AR) on perinatal mortality in severe twin-twin transfusion syndrome (TTTS).
  
  
  METHODS
  This was a 5 year multicenter, prospective, randomized controlled trial. The primary outcome variable was 30 day postnatal survival of donors and recipients.
  
  
  RESULTS
  There was no statistically significant difference in 30-day postnatal survival between SFLP or AR treatment for donors at 55% (11 of 20) vs 55% (11 of 20) (P = 1.0, odds ratio [OR] 1, 95% confidence interval [CI] 0.242 to 4.14) or recipients at 30% (6 of 20) vs 45% (9 of 20) (P = .51, OR 1.88, 95% CI 0.44 to 8.64). There was no difference in 30 day survival of 1 or both twins on a per-pregnancy basis between AR at 75% (15 of 20) and SFLP at 65% (13 of 20) (P = .73, OR 1.62, 95% CI 0.34 to 8.09). Overall survival (newborns divided by the number of fetuses treated) was not statistically significant for AR at 60% (24 of 40) vs SFLP 45% (18 of 40) (P = .18, OR 2.01, 95% CI 0.76 to 5.44). There was a statistically significant increase in fetal recipient mortality in the SFLP arm at 70% (14 of 20) vs the AR arm at 35% (7 of 20) (P = .25, OR 5.31, 95% CI 1.19 to 27.6). This was offset by increased recipient neonatal mortality of 30% (6 of 20) in the AR arm. Echocardiographic abnormality in recipient twin Cardiovascular Profile Score is the most significant predictor of recipient mortality (P = .055, OR 3.025/point) by logistic regression analysis.
  
  
  CONCLUSIONS
  The outcome of the trial did not conclusively determine whether AR or SFLP is a superior treatment modality. TTTS cardiomyopathy appears to be an important factor in recipient survival in TTTS.
authors: Fetal Care Center of Cincinnati, Division of Pediatric General, Thoracic, and Fetal Surgery, Cincinnati Children's Hospital, MLC #2023, 3333 Burnet Avenue, Cincinnati, OH 45229, USA. timothy.crombleholme@cchmc.org
authors: Timothy M
authors: TM
authors: Crombleholme
authors: David
authors: D
authors: Shera
authors: Hanmin
authors: H
authors: Lee
authors: Mark
authors: M
authors: Johnson
authors: Mary
authors: M
authors: D'Alton
authors: Flint
authors: F
authors: Porter
authors: Jacquelyn
authors: J
authors: Chyu
authors: Richard
authors: R
authors: Silver
authors: Alfred
authors: A
authors: Abuhamad
authors: George
authors: G
authors: Saade
authors: Laurence
authors: L
authors: Shields
authors: David
authors: D
authors: Kauffman
authors: Joanne
authors: J
authors: Stone
authors: Craig T
authors: CT
authors: Albanese
authors: Ray
authors: R
authors: Bahado-Singh
authors: Robert H
authors: RH
authors: Ball
authors: Larissa
authors: L
authors: Bilaniuk
authors: Beverly
authors: B
authors: Coleman
authors: Diana
authors: D
authors: Farmer
authors: Vickie
authors: V
authors: Feldstein
authors: Michael R
authors: MR
authors: Harrison
authors: Holly
authors: H
authors: Hedrick
authors: Jeffrey
authors: J
authors: Livingston
authors: Robert P
authors: RP
authors: Lorenz
authors: David A
authors: DA
authors: Miller
authors: Mary E
authors: ME
authors: Norton
authors: William J
authors: WJ
authors: Polzin
authors: Julian N
authors: JN
authors: Robinson
authors: Jack
authors: J
authors: Rychik
authors: Per L
authors: PL
authors: Sandberg
authors: Istvan
authors: I
authors: Seri
authors: Erin
authors: E
authors: Simon
authors: Lynn L
authors: LL
authors: Simpson
authors: Larisa
authors: L
authors: Yedigarova
authors: R Douglas
authors: RD
authors: Wilson
authors: Bruce
authors: B
authors: Young
mesh_terms: D000328:Adult; D000650:Amnion / Q000601:surgery*; D004200:Diseases in Twins / Q000601:surgery*; D005260:Female; D005330:Fetofetal Transfusion / Q000601:surgery*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D017075:Laser Coagulation / Q000379:methods*; D016015:Logistic Models; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome; D014427:Twins