Outcome following selective fetoscopic laser ablation for twin to twin transfusion syndrome: an 8 year national collaborative experience

• Published in: European journal of obstetrics & gynecology and reproductive biology 2015-08, Vol.191, p.125-129
• Main Authors: Müllers, Sieglinde M, McAuliffe, Fionnuala M, Kent, Etaoin, Carroll, Stephen, Mone, Fionnuala, Breslin, Noelle, Dalrymple, Jane, Mulcahy, Cecelia, O’Donoghue, Keelin, Martin, Aisling, Malone, Fergal D
• Format: Article
• Language: English
• Subjects: Child Development; Clinical Audit; Female; Fetal Development; Fetal therapy; Fetofetal Transfusion - diagnostic imaging; Fetofetal Transfusion - physiopathology; Fetofetal Transfusion - surgery; Fetoscopy - adverse effects; Gestational Age; Humans; Infant, Newborn; Ireland; Laser Therapy - adverse effects; Male; Neurodevelopmental Disorders - etiology; Neurodevelopmental Disorders - physiopathology; Neurodevelopmental Disorders - prevention & control; Neurodevelopmental outcome; Obstetrics and Gynecology; Perinatal outcome; Postoperative Complications - physiopathology; Postoperative Complications - prevention & control; Pregnancy; Premature Birth - etiology; Premature Birth - physiopathology; Premature Birth - prevention & control; Registries; Selective fetoscopic laser ablation; Severity of Illness Index; Survival Analysis; Twin to twin transfusion syndrome; Ultrasonography, Prenatal
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2015.05.019

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. Study design 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. Conclusion 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.