Perinatal outcome after fetoscopic laser surgery for twin-to-twin transfusion syndrome in triplet pregnancies.
OBJECTIVE
The introduction of fetoscopic laser surgery of placental anastomoses has led to a significant improvement of perinatal outcome of twin pregnancies affected by twin-to-twin-transfusion syndrome (TTTS). To quantify the perinatal outcome and neurological morbidity in triplet pregnancies complicated by TTTS, which were treated with fetoscopic laser surgery.


METHODS
Medline, Embase, Cinahl and Cochrane were searched.


METHODS
The outcomes observed were: fetal and perinatal survival, preterm birth and abnormal neurological outcome.


METHODS
Two authors reviewed all abstracts independently. Meta-analyses of proportions were used to combine data.


RESULTS
Eight studies (126 triplet pregnancies, 104 dichorionic-triamniotic [DCTA] and 22 monochorionic-triamniotic [MCTA]) treated with fetoscopic laser surgery were included in this review. In DCTA and MCTA pregnancies, fetal losses were 18.9% and 28.9%, respectively; perinatal losses were 23.6% and 75.0%; preterm births <28 weeks of gestation were 16.9% and 37.1%; preterm births <32 weeks of gestation were 50.0% and 69.5%; at least one fetus survived in 95.4% and 88.9% of the pregnancies; at least two fetuses survived in 81.8% and 68.3% of the pregnancies; and in 55.9% and 48.4% pregnancies all triplets survived. Finally, the incidence of abnormal neurological outcomes ranged from 0 to 37% in DCTA and from 0 to 50% in MCTA triplets.


CONCLUSIONS
Both DTCA and MCTA triplet pregnancies affected by TTTS are at high risk of adverse perinatal outcome.


CONCLUSIONS
Both DTCA and MCTA triplet pregnancies affected by TTTS are at high risk of adverse perinatal outcome.
Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK.
F
F
D'Antonio
Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK.
B
B
Thilaganathan
Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK.
J
J
Toms
Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy.|CeSI Biotech, Chieti, Italy.
L
L
Manzoli
Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK.
A
A
Bhide
Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK.
A
A
Papageorghiou
Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK.
A
A
Khalil
D005260:Female; D005330:Fetofetal Transfusion / Q000601:surgery*; D005332:Fetoscopy / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D053685:Laser Therapy; D011247:Pregnancy; D011256:Pregnancy Outcome; D059286:Pregnancy, Triplet
Outcome; triplet pregnancies; twin-to-twin transfusion syndrome