P06.09: Fetoscopic laser treatment for twin-twin transfusion syndrome: preliminary results from a new Italian center

Objectives: Our aim was to evaluate the initial results of selective
fetoscopic laser coagulation of placental equator for twin – to twin
transfusion syndrome (TTTS).
Methods: This was a prospective cohort study performed in a
tertiary referral centre. The sonoendoscopic approach was used
to identify the placental vascular equator and to photocoagulate
crossing vessels.
Results: Between April 2008 and March 2010, a total of 35
monochorionic diamniotic pregnancies, complicated by severe
twin–twin transfusion syndrome before 26 weeks of gestation,
underwent fetoscopic laser coagulation of placental blood vessels by
3 operators. Median gestational age was 20+1 weeks (interquartile
range (IQR) 18+1–22+6 weeks) at fetoscopy and 34+4 weeks (IQR
32+4–36+0 weeks) at birth. There was at least one survivor in
66% (23/35) of pregnancies, and the overall survival rate was 54%
(38/70). On average, seven vessels were ablated during each of
the procedures, with a median operative time of 40 minutes (IQR
30–50 minutes). Recurrence of TTTS complicated 11% (4/35) of
cases. Intraamniotic bleeding occurred in 2/35 patients. One of
these cases was further complicated by maternal hemoperitoneum
requiring blood transfusion and surgery.
Conclusions: Our results of fetoscopic laser treatment for twin–twin
transfusion syndrome are comparable to those reported in the
literature