The experience of modified sequential selective laser photocoagulation of communicating vessels technique for twin-twin transfusion syndrome.
OBJECTIVE
Fetoscopic laser photocoagulation of vascular anastomoses (FLP) is the essential choice in twin-twin transfusion syndrome (TTTS). We proposed that the modified sequential selective laser photocoagulation of communicating vessels (modified SQLPCV) to clarify the perinatal outcomes in TTTS.


METHODS
The modified SQLPCV was designed with the following order: 1, artery-to-artery anastomoses; 2, venous-to-venous anastomoses; 3, artery-to-venous anastomoses from donor to recipient; and 4, artery-to-venous anastomoses from recipient to donor. The perinatal outcomes were present in TTTS patients who underwent the modified SQLPCV.


RESULTS
A total of 203 women underwent modified SQLPCV. The mean pregnancy prolongation period was 83 days, and the mean gestational age at delivery was 33 weeks (range 23-40 weeks). There was a significantly lower rate of recipient fetal demise than donor fetal demise (4% vs. 13%; p < .01). The survival rate of zero and one were respectively 6% (13/203) and 19% (39/203). Two survivors were seen in 74% (151/203), and at least one survivor in 94% (190/203). Univariate and multivariate analysis showed that abnormal fetal Doppler measurements in donor were correlated with donor demise after surgery.


CONCLUSIONS
The modified SQLPCV represents satisfactory outcomes for fetuses complicating with TTTS.
a Department of Obstetrics and Gynecology , Kawasaki Medical School , Okayama , Japan.
Susumu
S
Murata
b Department of Obstetrics and Gynecology , Toho University Omori Medical Center , Tokyo , Japan.
Mayumi
M
Takano
a Department of Obstetrics and Gynecology , Kawasaki Medical School , Okayama , Japan.
Yukiko
Y
Kagawa
c Department of Obstetrics , Fukuoka Children's Hospital , Fukuoka , Japan.
Masahiro
M
Sumie
b Department of Obstetrics and Gynecology , Toho University Omori Medical Center , Tokyo , Japan.
Masahiko
M
Nakata
D000328:Adult; D005260:Female; D005313:Fetal Death; D005330:Fetofetal Transfusion / Q000196:embryology* / Q000401:mortality / Q000601:surgery*; D005865:Gestational Age; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012307:Risk Factors; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal
Laser surgery; fetal demise; modified sequential method; twin-twin transfusion syndrome