Coagulation laser en fœtoscopie des anastomoses vasculaires placentaires : étude observationnelle de 100 grossesses gémellaires monochoriales consécutives compliquées de syndrome transfuseur-transfusé sévère

Abstract

To report pre- and post-surgical datas of large series of severe twin-to-twin transfusion syndrome (TTTS) managed with laser ablation surgery in our centre, to evaluate the incidence of complications, perinatal outcome and to compare with other cohorts. Observational study of 100cases of TTTS consecutively treated with fetoscopic laser coagulation between January2004 and April2010 in CMCO-SIHCUS of Schiltigheim. There are nine stageI, 49 stageII, 38 stageIII and four stage4. Median gestation at time of laser is 20.6weeks (14-29) whereas median gestation at delivery is 32.6weeks (16.3-39). Overall perinatal survival rate is 68.5% (137children over 200). Eighty-five percent have one or more surviving twins. The survival rate is the same for donors and for recipients. Preterm premature rupture of the membranes are observed in 17% of cases and the median gestational age for this complication is 30weeks (20-34). Cerebral abnormalities are present in 7% of newborns. Our results for the management of severe TTTS are comparable to the other reported series. There are still many questions remaining concerning the optimal management of TTTS.