Invasive treatment in complicated monochorionic twin pregnancies: indications and outcome of 120 consecutively treated pregnancies.
OBJECTIVE
Monochorionic twin pregnancies are associated with increased risk of severe complications. Umbilical cord occlusion (UCO) and fetoscopic selective laser coagulation (FSLC) are used as invasive treatment. The study aim was to document treatment indications and pregnancy outcome where UCO and FSLC were used for treating fetal discrepancies and twin-to-twin transfusion syndrome (TTTS).


METHODS
Cohort study of all consecutively treated monochorionic twin pregnancies 2004-2010.


METHODS
Tertiary care center.


METHODS
One hundred and twenty pregnancies treated by FSLC (55) or UCO (65). Umbilical cord occlusion was undertaken in 49 TTTS cases, in four cases with fetal abnormality and TTTS and in 12 cases because of fetal anomaly only.


METHODS
Overall survival per fetus, survival per pregnancy of at least one fetus and further survival according to the Quintero stages. Infant survival until at least one week after birth.


RESULTS
Of the pregnancies studied, 84% had TTTS, 13% had a fetal malformation and 3% had both. Of TTTS cases, 69% were Quintero stage 3 and 4. In the UCO group with TTTS, 87% were in stage 3 and 4. Survival in the UCO group was 82%. In the laser group, the survival of at least one fetus was 85%. Overall survival per fetus was 60%.


CONCLUSIONS
By far the most common indication for invasive treatment was TTTS in Quintero stage 3. Outcome by means of survival after FSLC and UCO were similar to what has been reported elsewhere. Cord occlusion was an acceptable treatment alternative to fetoscopic selective laser coagulation in severe TTTS cases.
Department of Fetal Medicine and Ultrasound, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. karin.sundberg@rh.regionh.dk
Karin
K
Sundberg
Kirsten
K
Søgaard
Lisa Neerup
LN
Jensen
Katrine Vasehus
KV
Schou
Connie
C
Jørgensen
D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000401:mortality / Q000601:surgery*; D004200:Diseases in Twins / Q000401:mortality / Q000601:surgery*; D005260:Female; D005330:Fetofetal Transfusion / Q000401:mortality / Q000601:surgery*; D005332:Fetoscopy; D006801:Humans; D007231:Infant, Newborn; D017075:Laser Coagulation / Q000379:methods*; D011247:Pregnancy; D015996:Survival Rate; D016896:Treatment Outcome; D014430:Twins, Monozygotic; D014470:Umbilical Cord / Q000601:surgery*