Fetoscopic laser ablation therapy in monochorionic diamniotic twin pregnancies with twin-to-twin transfusion syndrome treated at a single centre over 10 years: a retrospective study

Anna Fichera; Vita Valentina Azzaretto; Nicola Fratelli; Sara Mancino; Daria Marella; Beatrice Negri; Adriana Valcamonico; Cristina Zanardini; Tiziana Frusca; Enrico Sartori; Federico Prefumo

doi:10.1515/jpm-2021-0058

Article

Fetoscopic laser ablation therapy in monochorionic diamniotic twin pregnancies with twin-to-twin transfusion syndrome treated at a single centre over 10 years: a retrospective study

Anna Fichera , Vita Valentina Azzaretto , Nicola Fratelli , Sara Mancino , Daria Marella , Beatrice Negri , Adriana Valcamonico , Cristina Zanardini , Tiziana Frusca , Enrico Sartori and Federico Prefumo

Published/Copyright: September 15, 2021

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From the journal Journal of Perinatal Medicine Volume 50 Issue 1

Abstract

Objectives

To review experience with fetoscopic laser ablation of placental anastomoses to treat monochorionic diamniotic (MCDA) twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) in a single centre over a ten-year period.

Methods

A retrospective study on 142 MCDA twin pregnancies complicates by TTTS treated with equatorial laser ablation of placental anastomoses (2008–2018). Solomon technique was also applied after 2013. Survival rates, neonatal outcome, intraoperative and post-laser complications were recorded, and prognostic factors analysed.

Results

A total of 133 cases were included in the final analysis; 41 patients were at stage II (30.8%), 73 were at stage III (62.9%), while only 12 (9%) at stage I and two patients (1.7%) at stage IV. Solomon technique was applied in 39 cases (29.3%). Survival of both twins was 51.1% (68/133), of a single twin 20.3% (27/133), and of at least one 71.5% (95/133), with an overall survival of 61.3% (163/266). TAPS and recurrent TTTS occurred in 8 (6%) and 15 (11.3%) patients. Survival of both fetuses increased over time (44.6 vs. 57.3%). A posterior placenta (p<0.003) and the use of the Solomon technique (p<0.02) were more frequent in cases with survival of both fetuses, while TTTS recurrence was significantly associated to the loss of one or two fetuses (p<0.01). Such associations were confirmed at logistic regression analysis.

Conclusions

Survival of both twins can improve over time and seems to be favourably associated with a placenta in the posterior location and the use of the Solomon technique.

Keywords: laser; monochorionic twin pregnancy; Solomon; survival; twin-to-twin transfusion syndrome (TTTS)

Corresponding author: Anna Fichera, Department of Obstetrics and Gynecology, Spedali Civili, Piazza Spedali Civili, 1, 25123 Brescia, Italy; and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy, Phone: +39 030 3995341, E-mail: anna.fichera@unibs.it

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Not applicable.
Ethical approval: The study was conducted in accordance with the 1964 Declaration of Helsinki. Since this was a retrospective study with no experimental research on participants, and all the procedures being performed were part of the routine care, no ethical committee approval was needed.

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Received: 2021-02-02

Accepted: 2021-08-26

Published Online: 2021-09-15

Published in Print: 2022-01-27

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Articles in the same Issue

https://doi.org/10.1515/jpm-2021-0058

Keywords for this article

laser; monochorionic twin pregnancy; Solomon; survival; twin-to-twin transfusion syndrome (TTTS)