Fetoscopic laser photocoagulation for amniotic fluid discordance bordering on twin–twin transfusion syndrome: Feasibility, perinatal and long‐term outcomes

• Published in: The journal of obstetrics and gynaecology research 2017-08, Vol.43 (8), p.1256-1262
• Main Authors: Ozawa, Katsusuke, Sugibayashi, Rika, Wada, Seiji, Sumie, Masahiro, Ishii, Keisuke, Nakata, Masahiko, Murakoshi, Takeshi, Ito, Yushi, Sago, Haruhiko
• Format: Article
• Language: English
• Subjects: Age; Amniotic fluid; amniotic fluid discordance; Discordance; Feasibility Studies; Female; Fetofetal Transfusion - prevention & control; fetoscopic laser photocoagulation; Fetoscopy - statistics & numerical data; Gestation; Hemiplegia; Humans; Laser Coagulation - statistics & numerical data; Lasers; monochorionic twin; Neurodevelopmental disorders; Pregnancy; Prenatal development; Prospective Studies; selective intrauterine growth restriction; Survival; Treatment Outcome; Twins; twin–twin transfusion syndrome; Velocity
• ISSN: 1341-8076; 1447-0756
• DOI: 10.1111/jog.13349

Aim This study investigated the feasibility and safety of fetoscopic laser photocoagulation (FLP) for amniotic fluid discordance (AFD) bordering on twin–twin transfusion syndrome (TTTS) with an absent or reverse end‐diastolic velocity (AREDV) in the umbilical artery (UA), and evaluated the perinatal and long‐term outcomes. Methods A prospective intervention study was performed between 20 + 0 and 25 + 6 weeks of gestation (UMIN000004165). AFD bordering on TTTS was defined as maximum vertical pocket (MVP) of amniotic fluid in one twin's sac ≤3 cm and amniotic fluid MVP in the other twin's sac ≥7 cm excluding TTTS. Neurodevelopmental outcome was evaluated at 6 months and at 3 years of age. Results Eleven women were treated without complications between September 2010 and July 2011. In all cases amnioinfusion was required, with a median surgical time of 70 min. There were nine cases of selective intrauterine growth restriction in which the growth discordant rate was >25%. The survival rates of the donor and recipient twins were 27.3% (3/11) and 100% (11/11), respectively. None of the surviving donor twins and two of the 11 recipient twins had hemiplegia at 6 months of age. One additional recipient twin had developmental delay at 3 years of age. Conclusions Fetoscopic laser photocoagulation for AFD bordering on TTTS with AREDV in the UA was feasible without complications but frequently resulted in donor twin death and a high survival rate of the recipient twin, albeit with neurodevelopmental abnormalities in some cases. FLP does not seem to be a promising treatment option for AFD bordering on TTTS.