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Outcome following selective fetoscopic laser ablation for twin to twin transfusion syndrome: an 8 year national collaborative experience.
- Source :
-
European journal of obstetrics, gynecology, and reproductive biology [Eur J Obstet Gynecol Reprod Biol] 2015 Aug; Vol. 191, pp. 125-9. Date of Electronic Publication: 2015 May 30. - Publication Year :
- 2015
-
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.<br />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.<br />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.<br />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.<br /> (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)
- Subjects :
- Child Development
Clinical Audit
Female
Fetal Development
Fetofetal Transfusion diagnostic imaging
Fetofetal Transfusion physiopathology
Gestational Age
Humans
Infant, Newborn
Ireland
Male
Neurodevelopmental Disorders etiology
Neurodevelopmental Disorders physiopathology
Postoperative Complications physiopathology
Pregnancy
Premature Birth etiology
Premature Birth physiopathology
Registries
Severity of Illness Index
Survival Analysis
Ultrasonography, Prenatal
Fetofetal Transfusion surgery
Fetoscopy adverse effects
Laser Therapy adverse effects
Neurodevelopmental Disorders prevention & control
Postoperative Complications prevention & control
Premature Birth prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1872-7654
- Volume :
- 191
- Database :
- MEDLINE
- Journal :
- European journal of obstetrics, gynecology, and reproductive biology
- Publication Type :
- Academic Journal
- Accession number :
- 26117441
- Full Text :
- https://doi.org/10.1016/j.ejogrb.2015.05.019