Twin-To-Laser Test

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Doppler assessment and survival after fetoscopic Laser surgery in twin-to-twin transfusion syndrome

Twin-to-twin transfusion syndrome (TTTS) is a severe condition that complicates fetuses that share the same placental territory causing an unbalance of blood flow from one fetus to the other. Ultrasound assessment through Doppler analysis is fundamental to establish the severity of the problem as well as the prognosis for both twins. The treatment for this condition has been demonstrated to be the endoscopic Laser photocoagulation of the communicating vessels. Thus, proper counselling on the different outcomes is critical for the whole management of the disease.

The purpose of this study is to report on the different …show more content…

All visible placental anastomoses were coagulated as well as the placental tissue between the coagulated vessels. Pre-Laser ultrasound data including Doppler assessment, surgical data, one-week post-Laser ultrasound data, and postnatal survival at hospital discharge were recorded and analyzed.

A total of 86 pregnancies with twin-to-twin transfusion syndrome were treated during the study period. Patients presenting selective fetal growth restriction (sFGR) with superimposed twin-to-twin transfusion syndrome were excluded from the analysis.
Median gestational age at laser therapy was 21.1 weeks (range 15.9-26.9 weeks). The survival rates of both and at least 1 twin were 70.9% and 84.9%, respectively. Donor survival was slightly lower compared with the recipient co-twin (75.5% vs 80.2%, respectively; P 0.58).
In cases with absent or reversed “a” wave in the recipient ductus venosus, recipient survival rate was significantly lower compared with the remaining twin-to-twin transfusion syndrome pregnancies (66.7% vs 87.5%; P < .05). There were no significant differences between the 2 groups in the survival of at least 1 twin, dual survival and in the donor

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