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Objective: In this prospective cohort study, we evaluated the initial results of fetoscopic laser surgery for severe second trimester twin-to-twin transfusion syndrome (TTTS) treated at our centre. Method: A total of 100 consecutive pregnancies with severe second trimester TTTS treated at our centre with selective fetoscopic laser coagulation of vascular anastomoses on the placental surface between August 2000 and November 2004 were included in the study. Perinatal survival was analysed in relation to Quintero stage. Results: Median gestational age was 20 weeks at fetoscopy (range: 16–26) and 33 weeks at delivery (range: 18–40). Perinatal survival rate was 70% (139/200). The treatment resulted in at least one survivor at the age of 4 weeks in 81% of pregnancies. Perinatal survival was significantly higher when treatment was performed in the early Quintero stages (95% in stage 1, 76% in stage 2, 70% in stage 3, 50% in stage 4) (p = 0.02). Conclusion: Results of fetoscopic laser surgery for TTTS in our centre are similar to those in specialised centres in other countries. Diagnosis and treatment in the early Quintero stages resulted in significantly higher perinatal survival. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: To compare the electrolyte composition of pregnancies complicated with twin-twin transfusion syndrome (TTTS) with that of physiologic pregnancies. Materials and Methods: Amniotic fluid samples from 16 pregnancies were studied. Specimens were obtained from recipient sacs in 10 pregnancies undergoing fetoscopy for severe midtrimester TTTS. Additionally, 6 amniotic fluid samples were obtained transcervically from legal second-trimester pregnancy terminations. The concentrations of sodium, potassium, chloride, bicarbonate, calcium, glucose, osmolality, pH, total protein content and albumin were determined in each sample. Results: The mean gestational age at sampling was 20.2 weeks (range 17.2–27.1) in the TTTS group and 18.4 (range 16.0–22.0) in the control group (p = NS). We found significant lower levels of albumin (0.22 ± 0.04 vs. 0.39 ± 0.11, p = 0.01) and total protein (0.19 ± 0.08 vs. 0.51 ± 0.17, p < 0.001) and higher levels of bicarbonate (16.90 ± 1.45 vs. 14.50 ± 2.17, p = 0.02) in amniotic fluid samples taken from recipient sacs of TTTS pregnancies. Conclusion: Amniotic fluid from the receptor in severe midtrimester TTTS differs significantly from control amniotic fluid samples in bicarbonate concentration, total protein content and albumin concentration. These findings may help to understand the pathophysiology of TTTS and to optimise therapeutic modalities. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]