The impact of laser therapy on fetal growth discordance in twin-to-twin transfusion syndrome

Abstract

OBJECTIVES: to evaluate the impact of laser therapy on inter-twin discordance in twin-to-twin transfusion syndrome (TTTS). METHODS: biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL) and estimated fetal weight were prospectively collected during a five-year period (1999 to 2004). The inter-twin discordance was expressed as a percentage of the largest twin's measurements. The measurements were made the day before laser, twice following laser and after delivery. The mean values of discordance in measurements and in fetal weight were calculated. ANOVA was used to compare mean values. RESULTS: the mean (SD) discordance for BPD, HC, AC, FL and estimated fetal weight the day before laser were 8.53% (5.28), 8.75% (2.76), 16.19% (4.85), 12.92% (5.13) and 28.50% (6.46) respectively. At the at 2nd ultrasound assessment after surgery were 4.37% (3.55), 3.73% (2.71), 8.90% (4.42), 6.61% (4.99) and 19.11% (8.01) respectively; and at birth the weight discordance was 18.55% (8.74). There was a significant decrease in discordance for HC and AC for each ultrasound assessment. CONCLUSIONS: there was a decrease in fetal growth discordance following laser therapy in TTTS. These changes might be related to re-adaptation of blood flow following laser therapy.