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Stage-Related Outcome in Twin–Twin Transfusion Syndrome Treated by Fetoscopic Laser Coagulation

From the ¹Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; ²Parexel Department of Biometry and Statistics, Westend Hospital, Berlin, Germany; and ³Department of Prenatal Diagnosis and Therapy, Allgemeines Krankenhaus Barmbek, Hamburg, Germany.

OBJECTIVE: To assess perinatal outcome in monochorionic twin pregnancies according to different stages of severe mid-trimester twin–twin transfusion syndrome managed by fetoscopic laser coagulation of the placental vascular anastomoses.

METHODS: In a prospective study fetoscopic laser therapy was performed in 200 consecutive pregnancies with severe mid-trimester twin–twin transfusion syndrome at a median gestational age of 20.7 weeks (range 15.9–25.3 weeks). Outcome data were analyzed for the whole group and separately for each stage according to the Quintero staging system.

RESULTS: The overall survival rate was 71.5% (286/400), with survival of both twins in 59.5% (119/200) and survival of at least one of the twins in 83.5% (167/200). The median gestational age at delivery of liveborn neonates was 34.3 weeks (range 23.1–40.4 weeks). There was a significant trend toward reduced survival rates with increasing stage (P=.038). The percentage of pregnancies with survival of both fetuses was 75.9% (22/29) for stage I, 60.5% (49/81) for stage II, 53.8% (43/80) for stage III, and 50% (5/10) for stage IV. At least one of the twins survived in 93.1% (27/29) at stage I, 82.7% (67/81) at stage II, 82.5% (66/80) at stage III, and 70% (7/10) at stage IV. The overall survival rate for donor fetuses was 70.5% (141/200) and for recipient fetuses, 72.5% (145/200).

CONCLUSION: These data show that laser therapy is an effective therapeutic option for all stages of severe twin–twin transfusion syndrome and provide information to counsel patients according to the stage of the syndrome.

LEVEL OF EVIDENCE: II-3