Fetoscopic Laser Ablation for the Selective Fetal Reduction in Twin-Twin Transfusion Syndrome Stage II–IV: The Experience of a New Fetal Medicine Center

Abstract

Nguyen Duy Anh,1,2 Ho Sy Hung,2 Nguyen Thi Sim,1 Nguyen Thi Thu Ha,3 Duc Lam Nguyen,2 Nguyen Duy Bac,4 Hoang Van Tong,5 Yves Ville,6 Phan Thi Huyen Thuong2,7 1Fetal Medicine Centre, Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam; 2Hanoi Medical University, Hanoi, Vietnam; 3Department of Assisted Reproductive and Andrology, Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam; 4Department of Education and Training, Vietnam Military Medical University, Hanoi, Vietnam; 5Biomedical and Pharmaceutical Applied Research Center, Vietnam Military Medical University, Hanoi, Vietnam; 6Department of Obstetrics and Fetal Medicine at Necker-Enfants-Malades Hospital at the Paris Descartes University, Paris, France; 7Department of Delivery, Hanoi Obstetrics and Gynecology Hospital, Hanoi, VietnamCorrespondence: Phan Thi Huyen Thuong, Hanoi Medical University, Hanoi, Vietnam, Tel [phone], Email [email protected]: To evaluate the surgery outcomes of fetoscopic laser ablation (FLA) for selective umbilical cord in treating twin-twin transfusion syndrome (TTTS) with special conditions and neonatal outcomes post-operation.Methods: A prospective study, 21 monochorionic diamniotic (MCDA) twins diagnosed with TTTS stage II–IV according to Quintero classification from 16 to 26 weeks of gestation, among that, 12 cases of TTTS stage II with selective intrauterine growth restriction (sIUGR), 6 cases of TTTS stage II with proximate cord insertions, 3 cases of TTTS stage IV underwent fetoscopic laser ablation for the selective fetal reduction at Hanoi Obstetrics and Gynecology Hospital from September 2019 to July 2021. Complications and surgical outcomes were noted. Prenatal care was carried out every 2 weeks post operation until birth. Newborn neurologic complications were assessed at birth, three months, and six months after birth using Denver II test and magnetic resonance imaging (MRI).Results: The mean gestational age at operation was 20.30 weeks. The average operation duration was 39.52 minutes. No complications of operation, such as bleeding or infection, were recorded. The mean gestational age at birth was 34.70 ± 4.33 weeks, with a mean duration of 12.97 ± 6.87 weeks between intervention and delivery. The survival rate of newborns after the operation was 90.48%. There were two stillbirths (9.52%) within seven days after the operation. No short-term neurological complications have been reported with follow-up of the newborn to 6 months after birth.Conclusion: Our study showed that fetoscopic laser ablation of selected fetal reduction surgery for treatment of special conditions of TTTS had no complications of operation, high neonatal survival result (90.48%), no short-term neurological complications. This should be considered for TTTS in cases of indication.Keywords: laser ablation, selective fetal reduction, twin-twin transfusion syndrome, new fetal medicine center

Keywords

• laser ablation
• selective fetal reduction
• twin-twin transfusion syndrome
• new fetal medicine center