Endoscopic laser surgery versus serial amniocenteses in the treatment of severe twin-twin transfusion syndrome☆,☆☆
Section snippets
Material and methods
Between January 1995 and May 1997 we performed endoscopic laser coagulation of the vascular placental anastomoses in 73 patients with severe twin-twin transfusion syndrome who were referred to our center in Hamburg. The results of the first 18 cases have been included in a previous report of a multicenter study.18 In all cases the parents gave written consent after intensive counseling and the study was approved by the ethics committee of the hospital. The following entry criteria for
Results
Patients treated with the laser coagulation method required just a single intervention in all but 1 case, whereas the median number of interventions in the group treated by serial amniocenteses was 3 (range 1-15) and 81% of continuing pregnancies needed >1 amniocentesis. The patient in whom polyhydramnios reoccurred after laser therapy was subsequently treated with serial amniocenteses.
Obstetric data at the time of laser coagulation or first amniocentesis are given in Table I.
Comment
As far as we are aware, this is the first study to directly compare pregnancy outcome after endoscopic laser surgery and after serial amniocenteses in the treatment of severe second trimester twin-twin transfusion syndrome. Each treatment group represents the largest number of cases reported from a single fetal medicine center. Laser surgery was associated with a higher chance of having ≥1 surviving twin per pregnancy, with a more advanced gestational age at delivery and with a higher birth
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Cited by (297)
Long-term outcomes for monochorionic twins after laser therapy in twin-to-twin transfusion syndrome
2018, The Lancet Child and Adolescent HealthSelective Laser Photocoagulation
2018, Obstetric Imaging: Fetal Diagnosis and Care: Second EditionSelective laser photocoagulation
2017, Obstetric Imaging: Fetal Diagnosis and Care, 2nd EditionTwin–twin transfusion syndrome in a monozygotic pregnancy with obvious lambda sign in first-trimester ultrasound
2016, Taiwanese Journal of Obstetrics and GynecologyA prospective pilot study of fetoscopic laser surgery for twin-to-twin transfusion syndrome between 26 and 27 weeks of gestation
2016, Taiwanese Journal of Obstetrics and Gynecology
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Reprint requests: Kurt Hecher, MD, Department of Prenatal Diagnosis and Therapy, AK Barmbek, Rübenkamp 148, 22291 Hamburg, Germany.
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0002-9378/99 $8.00 + 0 6/1/95479