title: [Laser ablation of the placental vascular anastomoses for the treatment of twin-to-twin transfusion syndrome].
abstract: OBJECTIVE
  To report the experience of the intrauterine treatment of monochorionic biamnotic (MC/BA) twin pregnancies complicated with twin-to-twin transfusion syndrome (TTTS) applying laser ablation of the placental vascular anastomoses (LAPVA).
  
  
  METHODS
  During 18 months period 35 MC/BA twin pregnancies were treated. TTTS was diagnosed based on the discrepancies in amniotic fluid and bladder size between both twins. Severity of TTTS was classified according to the hemodynamic changes in both twins. LAPVA was performed between 16-26 weeks of gestation using a rigid straight fetoscope and a YAG (neodymium: yttrium aluminium garnet) laser equipment. Survival was considered when the neonate was home discharged.
  
  
  RESULTS
  Overall survival was 62.8% (44/70 fetuses). In 77% of pregnancies (27/35) at least one twin survived, and in 48.5% (17/35) of cases both twins survived. Bleed was the most frequent complication (12/35; 34%). In 5 cases there was severe bleeding leading to late premature rupture of membranes and death of both twins. Median time stay in the neonatal intensive care unit was 20 days (range, 7-120). There were no signs of brain damage at the time of discharge.
  
  
  CONCLUSIONS
  These results are similar to those already published. Bleeding was the most frequent complication, however as the experience improved it was less frequent. Overall success is highly associated with a good neonatal care support.
authors.affiliation: Subdirección de Investigación Clínica, Institute Nacional de Perinatología Isidro Espinosa de los Reyes, México, DF. ehernandez@servidor.inper.edu.mx
authors.forename: Edgar
authors.initials: E
authors.lastname: Hernández-Andrade
authors.forename: Mario
authors.initials: M
authors.lastname: Guzmán-Huerta
authors.forename: Jesús A
authors.initials: JA
authors.lastname: Benavides-Serralde
authors.forename: Flavio
authors.initials: F
authors.lastname: Páez-Serralde
authors.forename: Lizbeth
authors.initials: L
authors.lastname: Camargo-Marín
authors.forename: Sandra
authors.initials: S
authors.lastname: Acevedo-Gallegos
authors.forename: Oscar
authors.initials: O
authors.lastname: Moreno-Alvarez
authors.forename: Javier
authors.initials: J
authors.lastname: Mancilla-Ramírez
mesh_terms: D005260:Female; D005330:Fetofetal Transfusion / Q000601:surgery; D006801:Humans; D017075:Laser Coagulation; D008137:Longitudinal Studies; D010920:Placenta / Q000098:blood supply* / Q000601:surgery*; D011247:Pregnancy