title: Fetal and maternal complications after selective fetoscopic laser surgery for twin-to-twin transfusion syndrome: a single-center experience.
abstract: OBJECTIVE
  To report the incidence of fetal and maternal complications after selective fetoscopic laser surgery for twin-to-twin transfusion syndrome (TTTS).
  
  
  METHODS
  A total of 150 cases of TTTS were treated from January 2004 to June 2009 (period 1, 2004-2006, 62 cases; period 2, 2007 to June 2009, 88 cases). Fetal complications (double and single intrauterine fetal death, recurrence of TTTS, twin anemia-polycythemia sequence (TAPS), reversal of TTTS, cerebral lesions in one twin) and maternal complications were recorded, and retrospectively analyzed.
  
  
  RESULTS
  Nineteen (12.6%), 58 (38.7%), 61 (40.7%) and 12 cases (8.0%) were classified preoperatively as Quintero stage I, II, III and IV, respectively. The anterior placenta was described in 73 cases (48.6%). Double and single fetal death occurred overall in 7.3 and 36.0% of cases, respectively. The rate of recurrence was 11.3%, of TAPS 3.3%, and of reversal of TTTS 1.3%. Cerebral lesions were diagnosed in 3 donors (2.0%). Eighteen cases (12.0%) of fetal complications had a second procedure (6 repeat laser, 4 serial amnioreduction, 8 bipolar cord coagulation). Pregnancies undergoing a second procedure delivered at a median gestational age of 30.2 weeks compared to 32.1 weeks for those not repeating (p = 0.04). Perinatal survival of at least one twin improved from 66.1 to 79.5% (p = 0.06) in the two consecutive periods. For every 10 laser surgeries performed, there was an average improvement of 1.5% in the predicted percentage of survival of at least one twin (OR 1.09, 95% CI 1.00-1.19). Major maternal complications occurred in 9 cases (6.0%), 3 of which required admission to intensive care unit.
  
  
  CONCLUSIONS
  Fetal complications are common after fetoscopic laser surgery. In this experience, an increasing number of procedures improved the performance of a new fetoscopic laser center.
authors.affiliation: Fetal Therapy Unit, Department of Obstetrics, Children's Hospital Vittore Buzzi, Università degli Studi di Milano, Milan, Italy. cast @ interware.it
authors.forename: M A
authors.initials: MA
authors.lastname: Rustico
authors.forename: M M
authors.initials: MM
authors.lastname: Lanna
authors.forename: S
authors.initials: S
authors.lastname: Faiola
authors.forename: V
authors.initials: V
authors.lastname: Schena
authors.forename: M
authors.initials: M
authors.lastname: Dell'avanzo
authors.forename: V
authors.initials: V
authors.lastname: Mantegazza
authors.forename: C
authors.initials: C
authors.lastname: Parazzini
authors.forename: G
authors.initials: G
authors.lastname: Lista
authors.forename: B
authors.initials: B
authors.lastname: Scelsa
authors.forename: D
authors.initials: D
authors.lastname: Consonni
authors.forename: E
authors.initials: E
authors.lastname: Ferrazzi
mesh_terms: D000740:Anemia / Q000209:etiology; D001927:Brain Diseases / Q000209:etiology; D016009:Chi-Square Distribution; D003422:Critical Care; D005260:Female; D005313:Fetal Death; D005330:Fetofetal Transfusion / Q000401:mortality / Q000601:surgery*; D005332:Fetoscopy / Q000009:adverse effects* / Q000401:mortality; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007558:Italy; D053685:Laser Therapy / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D016017:Odds Ratio; D011086:Polycythemia / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D059285:Pregnancy, Twin; D047928:Premature Birth / Q000209:etiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome