title: Timing of delivery following selective laser photocoagulation for twin-to-twin transfusion syndrome.
abstract: OBJECTIVE
  We sought to compare intrauterine risks with postnatal outcome in monochorionic pregnancies operated by fetoscopic laser surgery for twin-to-twin transfusion syndrome.
  
  
  METHODS
  A cohort of 602 consecutive cases was analyzed. Unexpected prenatal adverse events were identified when a fatal or potentially fatal event occurred that could have been avoided by timely delivery.
  
  
  RESULTS
  The prospective risk of an unexpected adverse event dropped from 16.8% (95% confidence interval [CI], 13.6-20.5%) to 0% (95% CI, 0-11%) between 26-36 weeks. At 32 weeks, the residual risk was 1 in 17 (95% CI, 1/28-1/11). The perinatal rate of death or severe brain lesions dropped from 35% (25-47%) in infants delivered at 26-28 weeks down to 3% (1-6%) at 34-36 weeks.
  
  
  CONCLUSIONS
  Our results did not identify an optimal cut-off for elective preterm delivery in laser-operated twin-to-twin transfusion syndrome. Perinatal morbidity appears low from ≥32 weeks and the decision for elective delivery should be based upon medical history, parental demand, and expert assessment.
authors: Department of Obstetrics and Maternal-Fetal Medicine, GHU Necker-Enfants Malades, Université Paris Descartes, France. j.stirnemann@gmail.com
authors: Julien J
authors: JJ
authors: Stirnemann
authors: Thibault
authors: T
authors: Quibel
authors: Mohammed
authors: M
authors: Essaoui
authors: Laurent J
authors: LJ
authors: Salomon
authors: Laurence
authors: L
authors: Bussieres
authors: Yves
authors: Y
authors: Ville
mesh_terms: D000037:Abruptio Placentae / Q000453:epidemiology; D000740:Anemia / Q000453:epidemiology; D001930:Brain Injuries / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data; D002821:Chorioamnionitis / Q000453:epidemiology; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D005313:Fetal Death / Q000453:epidemiology; D005316:Fetal Distress / Q000453:epidemiology; D005330:Fetofetal Transfusion / Q000601:surgery*; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007751:Labor, Induced / Q000706:statistics & numerical data; D017075:Laser Coagulation; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control; D012008:Recurrence; D018570:Risk Assessment