Fetal and maternal complications after selective fetoscopic laser surgery for twin-to-twin transfusion syndrome: a single-center experience

Fetal Diagn Ther. 2012;31(3):170-8. doi: 10.1159/000336227. Epub 2012 Mar 23.

Abstract

Objective: To report the incidence of fetal and maternal complications after selective fetoscopic laser surgery for twin-to-twin transfusion syndrome (TTTS).

Methods: A total of 150 cases of TTTS were treated from January 2004 to June 2009 (period 1, 2004-2006, 62 cases; period 2, 2007 to June 2009, 88 cases). Fetal complications (double and single intrauterine fetal death, recurrence of TTTS, twin anemia-polycythemia sequence (TAPS), reversal of TTTS, cerebral lesions in one twin) and maternal complications were recorded, and retrospectively analyzed.

Results: Nineteen (12.6%), 58 (38.7%), 61 (40.7%) and 12 cases (8.0%) were classified preoperatively as Quintero stage I, II, III and IV, respectively. The anterior placenta was described in 73 cases (48.6%). Double and single fetal death occurred overall in 7.3 and 36.0% of cases, respectively. The rate of recurrence was 11.3%, of TAPS 3.3%, and of reversal of TTTS 1.3%. Cerebral lesions were diagnosed in 3 donors (2.0%). Eighteen cases (12.0%) of fetal complications had a second procedure (6 repeat laser, 4 serial amnioreduction, 8 bipolar cord coagulation). Pregnancies undergoing a second procedure delivered at a median gestational age of 30.2 weeks compared to 32.1 weeks for those not repeating (p = 0.04). Perinatal survival of at least one twin improved from 66.1 to 79.5% (p = 0.06) in the two consecutive periods. For every 10 laser surgeries performed, there was an average improvement of 1.5% in the predicted percentage of survival of at least one twin (OR 1.09, 95% CI 1.00-1.19). Major maternal complications occurred in 9 cases (6.0%), 3 of which required admission to intensive care unit.

Conclusions: Fetal complications are common after fetoscopic laser surgery. In this experience, an increasing number of procedures improved the performance of a new fetoscopic laser center.

Publication types

  • Evaluation Study

MeSH terms

  • Anemia / etiology
  • Brain Diseases / etiology
  • Chi-Square Distribution
  • Critical Care
  • Female
  • Fetal Death
  • Fetofetal Transfusion / mortality
  • Fetofetal Transfusion / surgery*
  • Fetoscopy / adverse effects*
  • Fetoscopy / mortality
  • Gestational Age
  • Humans
  • Incidence
  • Italy
  • Laser Therapy / adverse effects*
  • Laser Therapy / mortality
  • Logistic Models
  • Odds Ratio
  • Polycythemia / etiology
  • Pregnancy
  • Pregnancy Complications / etiology*
  • Pregnancy Complications / mortality
  • Pregnancy Complications / surgery
  • Pregnancy, Twin
  • Premature Birth / etiology
  • Recurrence
  • Reoperation
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome