The outcome and prognostic factors of twin-twin transfusion syndrome following fetoscopic laser surgery.
OBJECTIVE
To evaluate the outcome and preoperative risks of twin-twin transfusion syndrome (TTTS) following fetoscopic laser surgery (FLS).


METHODS
A retrospective cohort study of a series of 181 consecutive cases of TTTS before 26 weeks' gestation subjected to FLS at four centers in Japan between July 2002 and December 2006.


RESULTS
The chances of survival of at least one twin at 28 days of age and 6 months of age were 91.2% and 90.1%, respectively. The rate of major neurological complications in survivors at 6 months of age was 4.7%. Preoperative findings that were significant risk factors for death were as follows: (1) being donor [odds ratio (OR): 3.01, 95% confidence interval (CI): 1.24-7.31, P = 0.015]; (2) reversed (OR: 11.78, CI: 3.05-45.55, P < 0.001) and absent (OR: 3.95, CI: 1.66-9.43, P = 0.002) end-diastolic velocity in the umbilical artery (EDV-UA) of the donor; and (3) reversed blood flow in the ductus venosus of the recipient (OR: 2.35, CI: 1.04-5.29, P = 0.040).


CONCLUSIONS
FLS leads to high survival rates and low neurological morbidity for fetuses in TTTS. FLS is an effective therapeutic option for TTTS before 26 weeks of gestation. Preoperative Doppler findings of the umbilical artery and the ductus venosus are useful in predicting prognosis following FLS.
Department of Maternal-Fetal and Neonatal Medicine, National Center for Child Health and Development, Tokyo, Japan. sagou-h@ncchd.go.jp
Haruhiko
H
Sago
Satoshi
S
Hayashi
Mari
M
Saito
Hiromi
H
Hasegawa
Hiroshi
H
Kawamoto
Naomi
N
Kato
Yukiko
Y
Nanba
Yushi
Y
Ito
Yuichiro
Y
Takahashi
Jun
J
Murotsuki
Masahiko
M
Nakata
Keisuke
K
Ishii
Takeshi
T
Murakoshi
D000328:Adult; D015331:Cohort Studies; D005260:Female; D046689:Fetal Mortality; D005330:Fetofetal Transfusion / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D005332:Fetoscopy / Q000379:methods* / Q000401:mortality / Q000534:rehabilitation; D005865:Gestational Age; D006801:Humans; D053685:Laser Therapy / Q000379:methods; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome