A prospective pilot study of fetoscopic laser surgery for twin-to-twin transfusion syndrome between 26 and 27 weeks of gestation

Abstract

Objective: The aim of this study is to clarify the feasibility and efficacy of fetoscopic laser photocoagulation of placental vascular communicating vessels (FLP) on twin–twin transfusion syndrome (TTTS) after 26 weeks of gestation. Materials and Methods: This is a prospective pilot study investigating all cases of TTTS between 26 weeks and 27 weeks during 2012 and 2013 in Japan. The primary endpoints in this study were the feasibility of FLP and rate of harmful complications for the mother's health. Also, perinatal prognosis was investigated. Results: Six cases were enrolled and underwent FLP. Two of the six cases were classified preoperatively as Quintero Stage II and four cases were Stage III. FLP was completely achieved in all six cases. No severe maternal complications were noted during and immediately after the surgery. All but one case continued the pregnancies > 14 days after FLP. The median gestational age at delivery was 33.4 weeks (28.0–36.6 weeks). All 12 fetuses survived at the 28th day in the neonatal period. No case was diagnosed with cerebral lesion at the neonatal period. Conclusion: This prospective pilot study shows that FLP could be a therapeutic option for TTTS between 26 weeks and 27 weeks of gestation.

Keywords

• fetal therapy
• fetoscopic surgery
• laser surgery
• monochorionic pregnancies
• twin-to-twin transfusion syndrome