title: Fetoscopic laser surgery for twin-to-twin transfusion syndrome after 26 weeks of gestation.
abstract: OBJECTIVE
  To compare the outcomes of twin-to-twin transfusion syndrome (TTTS) cases treated with fetoscopic laser coagulation of vascular anastomoses before 25 + 6 weeks of gestation and between 26 and 28 weeks of gestation.
  
  
  METHODS
  28 consecutive cases of TTTS at Quintero stages II-IV treated with laser therapy between 26 + 0 and 28 + 6 weeks of gestation were compared with 324 cases treated between 15 + 0 and 25 + 6 weeks during a 3-year period in two centers. The following data were recorded and compared: duration of the fetoscopy, rate of complications (preterm labor before 28 weeks and before 32 weeks, chorioamnionitis, twin anemia-polycythemia syndrome and recurrent TTTS), gestational age at delivery and neonatal survival rate.
  
  
  RESULTS
  The study groups were similar as regards Quintero staging and the frequency of anterior placental location (50.0 vs. 47.8%, p = 0.85 in late and conventional laser, respectively). There were no significant differences in the duration of surgery (29 vs. 30, p = 0.27, respectively) and in the rates of any of the complications evaluated. Gestational age at delivery (33 vs. 33.3 weeks, p = 0.69) and neonatal survival of at least one fetus (92.3 vs. 88.6%, p = 0.24) were also similar.
  
  
  CONCLUSIONS
  Fetoscopic laser coagulation for TTTS performed between 26 + 0 and 28 + 6 weeks of gestation was associated with similar outcomes as those observed in cases treated before 26 weeks.
authors.affiliation: Department of Maternal-Fetal Medicine (Institut Clínic de Ginecologia, Obstetrícia i Neonatologia), Hospital Clinic-IDIBAPS, University of Barcelona, Spain.
authors.forename: Dan V
authors.initials: DV
authors.lastname: Valsky
authors.forename: Elisenda
authors.initials: E
authors.lastname: Eixarch
authors.forename: Josep M
authors.initials: JM
authors.lastname: Martinez-Crespo
authors.forename: Emilia-Ruthy
authors.initials: ER
authors.lastname: Acosta
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Lewi
authors.forename: Jan
authors.initials: J
authors.lastname: Deprest
authors.forename: Eduard
authors.initials: E
authors.lastname: Gratacós
mesh_terms: D005260:Female; D005330:Fetofetal Transfusion / Q000601:surgery*; D005332:Fetoscopy; D005865:Gestational Age; D006801:Humans; D017075:Laser Coagulation; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D016896:Treatment Outcome