Laser treatment of twin-to-twin transfusion syndrome (TTTS): preliminary findings from a tertiary center in Greece

Abstract

Background: Twin- to-twin transfusion syndrome (TTTS) affects approximately 15% of monochorionic twin pregnancies with an estimated incidence of 1 in 1,600 pregnancies. The gold standard of care is considered to be Fetoscopic Laser Photocoagulation Therapy (FLPT). Objective: To present our experience with FLPT in a preliminary prospective observational study. Materials and methods: Fourteen patients who underwent FLPT in the Fetal Maternal Medicine Unit of Attikon University Hospital, between January 2017 and August 2018. Fetoscopic laser photocoagulation was offered to all patients with pregnancies complicated by TTTS (Quintero stage >2), before the completion of 26 weeks of gestation. Results: The mean gestational age at diagnosis was 22.2 ± 2.6 weeks, at surgery 23.1±1.9 weeks and at birth 29.8±3.3 weeks. Mean interval from surgery to delivery was 6.6±3.1 weeks and mean neonatal birthweight was 1426±408 grams. Mean recipient’s weight at delivery was 1652±283gr, whereas mean donor’s weight at delivery was 1299 ± 402gr. Concerning fetal viability, ten (71,4%) donor fetuses survived to full term whereas 4 (28,6%) donor fetuses died in utero. The survival rate of recipient fetuses reached 85,7% which is very good according to the literature. In total 22 fetuses (78,6%) were alive at birth and survived the first 6 months of life and in 6 cases an intrauterine demise occurred (21,4%). In 10 pregnancies (71,4%) both fetuses survived, in 2 (14,3%) both died and in 12 pregnancies (85,7%) there was at least one survivor. Conclusion: These preliminary results support the use of FPLT in Greece as the percentage of live neonates that was reached is comparable to those published in larger studies in the international literature. We are confident that with increasing experience and new instrumentation, these results will become even better and this service will accept more cases all over Greece.