TTTS after 26 weeks gestation : is there a role for fetoscopic laser surgery ?

Objective: To compare fetoscopic laser surgery with amniodrainage in the treatment of twin-to-twin transfusion syndrome (TTTS) diagnosed after 26 weeks’ gestation. Methods: Treatment of TTTS consisted of either amniodrainage or fetoscopic laser coagulation of vascular anastomoses. Primary outcome was adverse outcome (intrauterine or neonatal death, major neonatal morbidity and/or severe cerebral injury). Secondary outcome was gestational age at birth. Results: Eleven TTTS cases were treated with amniodrainage and ten with laser surgery. Median gestational age at birth in the amniodrainage group and laser surgery group was 29 and 31 weeks respectively (p = 0.17) All infants were born alive. Major neonatal morbidity occurred more often in the amniodrainage group than in the laser surgery group, 27% (6/22) and 0% (0/20) respectively (p = 0.02). Severe cerebral injury in the amniodrainage group and laser surgery group occurred in 23% (5/22) and 15% (3/20) respectively (p = 0.70). Neonatal mortality in the amniodrainage group and laser surgery group was 14% (3/22) and 0% (0/20) respectively (p = 0.23). Overall adverse outcome was 36% (8/22) in the amniodrainage group and 15% (3/20) in the laser surgery group (p = 0.17). Conclusions: In TTTS diagnosed after 26 weeks’ gestation, amniodrainage and laser surgery both result in 100% survival. However, infants born after laser surgery have less major neonatal morbidity.