title: Audit of immediate outcomes for MCDA twins following laser therapy for twin-twin transfusion syndrome at the NSW Fetal Therapy Centre.
abstract: OBJECTIVE
  To audit immediate pregnancy and neonatal outcomes of selective laser photocoagulation of communicating vessels (SLPCV) for twin-twin transfusion syndrome (TTTS) at the New South Wales Fetal Therapy Centre.
  
  
  METHODS
  Retrospective cohort study of 151 TTTS cases undergoing SLPCV between July 2003 and May 2013, evaluating procedural details, delivery and perinatal outcomes.
  
  
  RESULTS
  The majority of cases were Stage III at SLPCV (56.9%), although proportion of Stage II SLPCV increased over time (P = 0.03). Survival to hospital discharge of at least one baby was 85.6% and dual survival was 52.5%. Median gestational age at delivery was 32.6 weeks (IQR 29.0-35.0 weeks) with a median of 11.4 weeks (IQR 8.3-14.7) from laser to delivery. Median birthweight was 1792 g (IQR 1288-2233 g), with 75% of babies admitted to the nursery, predominantly secondary to prematurity. Immediate SLPCV complications were in utero fetal demise <1 week postprocedure in 27 fetuses (19.6%) and/or ruptured membranes <1 week postprocedure in 9 fetuses (6.6%).
  
  
  CONCLUSIONS
  This Australian series shows that local outcomes after SLPCV for stages II-IV TTTS remain equal to the international published literature and have remained stable after an initial learning curve. Women were more likely to be Stage II rather than III in the more recent years. However, this does not appear to be attributable to altered referral patterns.
authors.affiliation: School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Isabella
authors.initials: I
authors.lastname: Wilson
authors.affiliation: School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.|Department of Maternal Fetal Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.|Women's and Children's Health, St George Hospital, Sydney, New South Wales, Australia.
authors.forename: Amanda
authors.identifier: http://orcid.org/0000-0002-7351-8922
authors.initials: A
authors.lastname: Henry
authors.affiliation: School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Ellen
authors.initials: E
authors.lastname: Hinch
authors.affiliation: School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.|Department of Obstetrics & Gynaecology, King Saud Hospital, Riyadh, Saudi Arabia.
authors.forename: Neama
authors.initials: N
authors.lastname: Meriki
authors.affiliation: Department of Maternal Fetal Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Challis
authors.affiliation: Department of Maternal-Fetal Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Smoleniec
authors.affiliation: School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.|Department of Maternal Fetal Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.
authors.forename: Alec William
authors.initials: AW
authors.lastname: Welsh
mesh_terms: D001724:Birth Weight; D005260:Female; D005313:Fetal Death / Q000209:etiology; D005322:Premature Rupture of Fetal Membranes / Q000209:etiology; D005330:Fetofetal Transfusion / Q000150:complications / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D017075:Laser Coagulation / Q000009:adverse effects; D008485:Medical Audit; D011247:Pregnancy; D059285:Pregnancy, Twin; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
keywords: SLPCV; TTTS; fetus; ultrasound