Laser surgery in twin-twin transfusion syndrome with proximate cord insertions

Objective: To estimate the prevalence of proximate cord insertions in twin-twin transfusion syndrome (TTTS) and evaluate the outcome after fetoscopic laser coagulation surgery. Methods: We included all TTTS cases treated with laser at our center between 2002 and 2013. Placentas were examined after birth and injected with colored dye. TTTS cases without complete placental injection study were excluded. We recorded the presence of proximate cord insertions (distance < 5 cm) after birth and the presence and types of residual anastomoses. We compared the clinical outcome and placental findings in cases with and without proximate cord insertions. Results: The prevalence of proximate cord insertions in TTTS placentas was 2% (4/252). Perinatal mortality in the TTTS group with and without proximate cord insertions was 13% (1/8) and 12% (61/496), respectively (P = 1.0). Residual anastomoses were detected in all placentas with proximate cord insertions (100%, 4/4) compared to 27% (66/248)(P < .01) in TTTS placentas without proximate cord insertions. Conclusion: Fetoscopic laser coagulation in TITS cases with proximate cord insertions is challenging due to technical difficulties in visualizing the vascular equator and results in an increased risk of incomplete laser treatment. (C) 2013 Elsevier Ltd. All rights reserved.