BACKGROUND
Ample evidence supports fetoscopic laser photocoagulation of placental anastomoses
as a first-line treatment for twin-to-twin transfusion syndrome, but little is known
about the outcomes following procedures conducted in the early second trimester.
OBJECTIVE
This study aimed to evaluate perinatal outcomes following early fetoscopic laser placental
photocoagulation performed for twin-to-twin transfusion syndrome at 16 weeks’ gestation.
STUDY DESIGN
This retrospective review included monochorionic twin pregnancies complicated by twin-to-twin
transfusion syndrome necessitating fetoscopic laser photocoagulation at a single tertiary
center from 2012 to 2021. The 2 cohorts were defined as cases undergoing laser surgery
at 16+0/7 to 16+6/7 weeks’ gestation (early laser group) and those undergoing laser
surgery ≥17 weeks’ gestation (standard laser group), respectively. Primary outcomes
included rates of immediate chorioamniotic membrane separation, preterm premature
rupture of membranes, and clinical chorioamnionitis. Secondary outcomes included twin
survival rates at birth and 30 days of life. Outcomes were compared between cohorts
with a P value of <.05 denoting statistical significance.
RESULTS
A total of 343 cases were included (35 early laser participants and 308 standard laser
participants). The early laser group typically had higher Quintero staging at the
time of the procedure. Following intervention, the early laser group had significantly
higher rates of chorioamniotic separation than the standard laser group (34.3% vs
1.3% of cases; P<.001) and higher rates of preterm prelabor rupture of membranes (45.7% vs 25.0%;
P=.009) and chorioamnionitis (11.4% vs 1.3%; P=.005). Even after adjustment for higher Quintero staging in the early laser group,
twin survival was not significantly different between study groups.
CONCLUSION
Early laser surgery for twin-to-twin transfusion syndrome performed at 16 weeks’ gestation
is associated with significantly higher rates of chorioamniotic separation, preterm
rupture of membranes, and chorioamnionitis. However, twin survival does not seem to
be negatively impacted following early laser surgery.
Keywords
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Article info
Publication history
Published online: October 13, 2022
Accepted:
October 8,
2022
Received in revised form:
October 5,
2022
Received:
July 12,
2022
Footnotes
The authors report no conflict of interest.
This study did not receive funding.
This study was presented as a poster at the 42nd annual pregnancy meeting of the Society for Maternal-Fetal Medicine, Kissimmee, FL, January 31–February 5, 2022.
Cite this article as: Seaman RD, Salmanian B, Shamshirsaz AA, et al. Pregnancy outcomes following early fetoscopic laser photocoagulation for twin-to-twin transfusion syndrome at 16 weeks’ gestation. Am J Obstet Gynecol MFM 2022;XX:x.ex–x.ex.
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© 2022 Published by Elsevier Inc.
