title: Establishing a national program for fetoscopic guided laser occlusion for twin-to-twin transfusion syndrome in Sweden.
abstract: OBJECTIVE
  To describe the establishment of the fetoscopic guided laser occlusion (FLOC) technique for treatment of twin-to-twin transfusion syndrome (TTTS) and the initial results in a Swedish national center.
  
  
  METHODS
  Retrospective, descriptive study.
  
  
  METHODS
  Tertiary level university hospital.
  
  
  METHODS
  All referred and treated cases suffering significant TTTS.
  
  
  METHODS
  The present study includes all cases of FLOC for TTTS at the Center of Fetal Medicine at Karolinska University Hospital, Stockholm, Sweden from October 2001 until December 2009. Patients were referred from all over Sweden and a few from other Nordic countries. The patients were evaluated with ultrasound examination between gestational ages of 18 and 26 weeks. Data from patients were extracted from our electronic medical record system and, in addition, families were contacted and medical records requested from referring hospitals.
  
  
  METHODS
  Pregnancies with one or more surviving infants after FLOC treatment categorized according to stage of TTTS.
  
  
  RESULTS
  In 75% of pregnancies, one or more infant was born alive. At stage I, both infants survived in one pregnancy and one survived in the second. There was no significant difference between cases at stage II or III, i.e. 73 vs. 78% of pregnancies resulted in one or more surviving infant. At stage IV, 66% of pregnancies ended with one or more surviving infant.
  
  
  CONCLUSIONS
  Treatment of TTTS is feasible in a rather small country like Sweden, with comparable results to other centers. There are strong arguments for centralization and further improvement of this kind of highly specialized treatment.
authors.affiliation: Karolinska Institute, Center of Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden. sverker.ek@karolinska.se
authors.forename: Sverker
authors.initials: S
authors.lastname: Ek
authors.forename: Marius
authors.initials: M
authors.lastname: Kublickas
authors.forename: The-Hung
authors.initials: TH
authors.lastname: Bui
authors.forename: Annika
authors.initials: A
authors.lastname: Dellgren
authors.forename: Nikos
authors.initials: N
authors.lastname: Papadogiannakis
authors.forename: Eleonor
authors.initials: E
authors.lastname: Tiblad
authors.forename: Elle
authors.initials: E
authors.lastname: Wågström
authors.forename: Magnus
authors.initials: M
authors.lastname: Westgren
mesh_terms: D005240:Feasibility Studies; D005260:Female; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005332:Fetoscopy; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D017075:Laser Coagulation / Q000379:methods*; D011247:Pregnancy; D016730:Program Development; D012189:Retrospective Studies; D015996:Survival Rate; D013548:Sweden; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal