title: [Laser ablation of placental vessels for treatment of severe twin-twin transfusion syndrome--experience from an university center in Brazil].
abstract: OBJECTIVE
  To describe the results of laser ablation of placental vessels for the treatment of severe twin-to-twin transfusion syndrome in an university center in Brazil.
  
  
  METHODS
  Retrospective observational study of patients treated at UNICAMP from 2007 to 2009. Laser ablation of placental vessels was performed in cases of severe twin-twin transfusion syndrome (Quintero stages II, III and IV) diagnosed before 26 complete weeks of gestation. The main variables evaluated in this series were gestational age at delivery, survival (discharge from the nursery) of at least one twin and neurological damage in survivors. Logistic regression was used to investigate the influence of cervical length, gestational age and stage of the disease (before the surgery) on the occurrence of delivery/abortion and fetal death after the intervention, and the influence on severe preterm birth and survival.
  
  
  RESULTS
  In the whole series, at least one twin survived in 63.3% of cases (19/30). Among patients who did not have delivery/abortion after surgery, the survival of at least one twin was 82.6% (19/23). In this subgroup (n=23), mean gestational age in delivery was 31.9 weeks and neurological damage was identified in one neonate (1/31; 3.2%). Cervix length influenced the occurrence of delivery/abortion after surgery (p-value=0.008). Among seven patients (7/30; 23.3%) who carried this complication, five (5/7; 71.4%) had cervix length lower than 15 mm. Among the 23 patients who did not have delivery/abortion as a result of the surgery, the highest stages of the disease (III and IV) increased the risk of delivery prior to 32 complete weeks of gestation (p-value=0.025) and decreased the chance of survival of both twins (p-value=0.026).
  
  
  CONCLUSIONS
  The results are similar to those available in the literature. In our series, the main factors associated with poorer results were short cervix (lower than 15 mm) and the highest stages of the disease (III and IV) at the time of the treatment.
authors.affiliation: Departamento de Obstetrícia e Ginecologia, Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas, Campinas, SP, Brasil. cfaperalta@hotmail.com
authors.forename: Cleisson Fábio Andrioli
authors.initials: CF
authors.lastname: Peralta
authors.forename: Luciana Emy
authors.initials: LE
authors.lastname: Ishikawa
authors.forename: João Renato
authors.initials: JR
authors.lastname: Bennini
authors.forename: Angélica de Fátima Assunção
authors.initials: Ade F
authors.lastname: Braga
authors.forename: Izilda Rodrigues Machado
authors.initials: IR
authors.lastname: Rosa
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Biondi
mesh_terms: D000328:Adult; D001938:Brazil; D005260:Female; D005330:Fetofetal Transfusion / Q000601:surgery; D006785:Hospitals, University; D006801:Humans; D053685:Laser Therapy; D010920:Placenta / Q000098:blood supply* / Q000601:surgery*; D011247:Pregnancy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult