Twin-to-twin transfusion syndrome after 26 weeks of gestation: is there a role for fetoscopic laser surgery?

Objective To compare fetoscopic laser surgery with amniodrainage in the treatment of twin-to-twin transfusion syndrome (TTTS) diagnosed after 26 weeks of gestation. Design A retrospective cohort study. Setting Leiden University Medical Centre, a tertiary referral hospital for fetal therapy. Population Between January 1991 and February 2006, 21 TTTS cases were diagnosed and treated after 26 weeks of gestation. Methods Treatment of TTTS consisted of either amniodrainage or fetoscopic laser coagulation of vascular anastomoses. Main outcome measures primary outcome: adverse outcome (intrauterine or neonatal death, major neonatal morbidity and/or severe cerebral injury). Secondary outcome: gestational age at birth. Results Eleven TTTS cases were treated with amniodrainage and ten with laser surgery. Median gestational age at birth in the amniodrainage group and in the laser surgery group was 29 and 31 weeks, respectively (P = 0.17) All infants were born alive. Major neonatal morbidity occurred more often in the amniodrainage group than in the laser surgery group, 27% (6/22) and 0% (0/20), respectively (P = 0.02). Severe cerebral injury in the amniodrainage group and in the laser surgery group occurred in 23% (5/22) and 15% (3/20) of infants, respectively (P = 0.70). Neonatal mortality in the amniodrainage group and in the laser surgery group was 14% (3/22) and 0% (0/20), respectively (P = 0.23). Overall adverse outcome was 36% (8/22) in the ammodrainage group and 15% (3/20) in the laser surgery group (P = 0.17). Conclusion In TTTS diagnosed after 26 weeks of gestation, amniodrainage and laser surgery both result in 100% survival. However, infants born after laser surgery have less major neonatal morbidity.