Pregnancy outcome after fetoscopic laser photocoagulation for twin-twin transfusion syndrome: experience of an emerging center from China

Abstract

To evaluate pregnancy outcomes after selective fetoscopic laser photocoagulation (SFLP) for twin-to-twin transfusion syndrome (TTTS). A total of 33 cases of TTTS were treated by SFLP in Shanghai First Maternity and Infant Hospital from January 2012 to August 2013. Clinical data on perinatal outcomes, fetaland maternalcomplicationswere recorded and retrospectively analyzed. (1) The mean gestational age for SFLP was (22.0 ± 2.3) weeks, the mean time for SFLP was (86 ± 32) minutes, the mean gestational age for delivery was 33(+6) weeks, the gestational age between SFLP and delivery was (9 ± 5) weeks. (2) The perinatal survival rate 28 days after the delivery was 70% (46/66). The survival rate was 52% (17/33) for both twins, 36% (12/33) for one twin, 88% (29/33) for at least one twin. Of all the survival twins, there were 21 donor twins (64%, 21/33) with the mean birth weight at delivery was (1 805 ± 523) g and 25 recipient twins (76%, 25/33) with the mean birth weight (2 214 ± 600) g. (3) There were 4 cases at TTTS stage I, 9 at TTTS stage II, 11 at TTTS stage III, 9 at TTTS stage IV; the survival number for at least one twin was 4, 7, 10, 8 respectively; the total survival rate was 7/8, 12/18, 68% (15/22), 12/18 respectively. (4) Four cases had both twins demises. 3 fetuses had special fetal complications with 2 of them developing twin anemia-polycythemia sequence (TAPS). Two cases had preterm premature rupture of membrane (PPROM) within 3 weeks after SFLP. (5) Placental injections were performed in 7 cases with SFLP after delivery. Residual anastomosis was identified in one case. As an emerging center, our study demonstrated favorable fetal outcomes with less maternal complications after SFLP for TTTS.