title: Are patients with twin-twin transfusion syndrome and a very short cervix candidates for laser surgery?
abstract: OBJECTIVE
  The purpose of this study was to determine the relationship between cervical length (CL) and perinatal outcomes in cases of twin-twin transfusion syndrome (TTTS) treated with laser surgery and to assess whether patients with a very short cervix (0.5-1.9 cm) are appropriate candidates for laser surgery.
  
  
  METHODS
  All women who underwent laser surgery for TTTS from March 2006 to April 2008 at the study institution were evaluated consecutively. Patients were grouped according to pre-operative CL: greater than 2.5, 2 to 2.5, and 0.5 to 1.9 cm. The gestational age at delivery, latency from laser surgery to delivery, and 30-day neonatal survival were documented prospectively and compared among these groups.
  
  
  RESULTS
  The 99 women in the study population were grouped by CL: greater than 2.5 cm (n = 76), 2 to 2.5 cm (n = 13), and 0.5 to 1.9 cm (n = 10). For these groups, the median gestational ages at delivery were 34, 32.29, and 31.86 weeks, respectively (P = .411). The median latencies from laser surgery to delivery were 12.79, 11, and 11.07 weeks (P = .424). The frequency rates of at least 1 surviving twin were 69 of 76 (91%), 13 of 13 (100%), and 8 of 10 (80%) (P = .254). Finally, dual survivors were observed in 54 of 76 (71%), 12 of 13 (92%), and 5 of 10 (50%) (P = .08).
  
  
  CONCLUSIONS
  In cases of TTTS complicated by a very short cervix (0.5-1.9 cm), treatment with laser surgery resulted in perinatal outcomes that were sufficiently favorable to justify the surgery, suggesting that these patients should not be excluded from undergoing laser surgery for TTTS.
authors.affiliation: Division of Maternal-Fetal Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA 90027, USA.
authors.forename: Emiliano R
authors.initials: ER
authors.lastname: Chavira
authors.forename: Amer
authors.initials: A
authors.lastname: Khan
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Korst
authors.forename: David
authors.initials: D
authors.lastname: Miller
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Goodwin
authors.forename: Ramen H
authors.initials: RH
authors.lastname: Chmait
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D018579:Patient Selection; D011247:Pregnancy; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal / Q000379:methods*; D055815:Young Adult