title: Outcome following selective fetoscopic laser ablation for twin to twin transfusion syndrome: an 8 year national collaborative experience.
abstract: OBJECTIVE
  With the recognition of the role of fetoscopic laser ablation for twin to twin transfusion syndrome (TTTS), there is a requirement for auditable standards for this technically challenging and specialized treatment. The purpose of this study is to report on the perinatal and medium-term neurodevelopmental outcomes following an 8-year national single center experience in the management of TTTS using the selective fetoscopic laser ablation technique.
  
  
  METHODS
  An audit of all cases of TTTS treated with selective laser ablation by a single national fetal medicine team was performed. Overall perinatal survival and medium-term neurodevelopmental outcomes were reported and correlated with gestational age at diagnosis, placental location, volume of amnio-reduction, Quintero staging and percentage inter-twin growth discordance. Procedure-related complications were recorded.
  
  
  RESULTS
  The overall fetal survival for the first 105 consecutive cases of TTTS was 61% (128/210 fetuses). Dual survival occurred in 47% (49/105) of cases, and with a single survival rate of 28% (30/105), perinatal survival of least one infant was achieved in 75% (79/105) of cases. No correlation was found between any clinical or sonographic marker and perinatal outcome, although dual survival was noted to be significantly decreased with increasing Quintero stage (p=0.041). Currently, 86% of survivors have been reported to have a normal medium-term neurological outcome.
  
  
  CONCLUSIONS
  Fetoscopic laser ablation is the established optimal treatment for severe twin to twin transfusion syndrome (TTTS). We report comparable short and medium-term outcomes following the selective fetoscopic technique comparing results from our national program with internationally published single-center outcomes, supporting the efficacy and safety of this treatment at our center.
authors.affiliation: Obstetrics & Gynecology, Rotunda Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland. Electronic address: siglindemuellers@rcsi.ie.
authors.forename: Sieglinde M
authors.initials: SM
authors.lastname: Müllers
authors.affiliation: UCD Obstetrics & Gynecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland.
authors.forename: Fionnuala M
authors.initials: FM
authors.lastname: McAuliffe
authors.affiliation: Obstetrics & Gynecology, Rotunda Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Etaoin
authors.initials: E
authors.lastname: Kent
authors.affiliation: Obstetrics & Gynecology, National Maternity Hospital, Dublin, Ireland.
authors.forename: Stephen
authors.initials: S
authors.lastname: Carroll
authors.affiliation: Obstetrics & Gynecology, National Maternity Hospital, Dublin, Ireland.
authors.forename: Fionnuala
authors.initials: F
authors.lastname: Mone
authors.affiliation: Obstetrics & Gynecology, Rotunda Hospital, Dublin, Ireland.
authors.forename: Noelle
authors.initials: N
authors.lastname: Breslin
authors.affiliation: Obstetrics & Gynecology, Rotunda Hospital, Dublin, Ireland.
authors.forename: Jane
authors.initials: J
authors.lastname: Dalrymple
authors.affiliation: Obstetrics & Gynecology, National Maternity Hospital, Dublin, Ireland.
authors.forename: Cecelia
authors.initials: C
authors.lastname: Mulcahy
authors.affiliation: Obstetrics & Gynecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland.
authors.forename: Keelin
authors.initials: K
authors.lastname: O'Donoghue
authors.affiliation: Obstetrics and Gynecology, The Coombe Women and Infants University Hospital, Dublin, Ireland.
authors.forename: Aisling
authors.initials: A
authors.lastname: Martin
authors.affiliation: Obstetrics & Gynecology, Rotunda Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Fergal D
authors.initials: FD
authors.lastname: Malone
mesh_terms: D002657:Child Development; D054869:Clinical Audit; D005260:Female; D047109:Fetal Development; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005332:Fetoscopy / Q000009:adverse effects*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007494:Ireland; D053685:Laser Therapy / Q000009:adverse effects*; D008297:Male; D065886:Neurodevelopmental Disorders / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control*; D011247:Pregnancy; D047928:Premature Birth / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D012042:Registries; D012720:Severity of Illness Index; D016019:Survival Analysis; D016216:Ultrasonography, Prenatal
keywords: Fetal therapy; Neurodevelopmental outcome; Perinatal outcome; Selective fetoscopic laser ablation; Twin to twin transfusion syndrome