Laser therapy and serial amnioreduction as treatment for twin-twin transfusion syndrome: a metaanalysis and review of literature.
OBJECTIVE
The objective of the study was to review current controversy on laser therapy (LT) vs serial amnioreduction (SA) performed for twin-twin transfusion syndrome (TTTS).


METHODS
A search in PubMed from 1997-2007 was performed. Inclusion criteria were diamniotic monochorionic pregnancy, TTTS diagnosed with standard parameters, and peri- and neonatal outcomes well defined. Triplets and investigations on other topics of TTTS rather than perinatal outcomes were excluded. A metaanalysis was performed by fixed-effect model (heterogeneity <25%).


RESULTS
Ten articles provided 611 cases of TTTS (LT: 70%; SA: 30%) and included 4 studies comparing the 2 treatments (395 cases: LT, 58%; SA, 42%). Fetuses undergoing LT were more likely to survive than fetuses undergoing SA (overall survival rate: P < .0001; odds ratio [OR], 2.04; 95% confidence interval [CI], 1.52-2.76; neonatal death: P < .0001; OR, 0.24; 95% CI, 0.15-0.40; neurologic morbidity: P < .0001; OR, 0.20; 95% CI, 0.12-0.33).


CONCLUSIONS
This metaanalysis shows that LT is associated with better outcomes than SA and proposes new topics for future research.
Rossi
A Cristina
AC
IV Clinic of Obstetrics and Gynecology, University of Bari, Bari, Italy. acristinarossi@yahoo.it
D'Addario
Vincenzo
V
D000653:Amniotic Fluid; D005260:Female; D005330:Fetofetal Transfusion / Q000401:mortality / Q000628:therapy*; D006801:Humans; D053685:Laser Therapy; D011247:Pregnancy; D011295:Prenatal Care; D016019:Survival Analysis; D016896:Treatment Outcome