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Ryan GA, Finnegan C, McAuliffe FM, Malone FD, Müllers SM, Corcoran S, Mulcahy C, Dalrymple J, Donnelly J, Walsh J, Mcparland P, Martin A, Carroll S, Kent E. Fetoscopic Laser Ablation for Twin-to-Twin Transfusion Syndrome: A 15-year Review of Perinatal Survival. Ir Med J 2022; 115:595. [PMID: 35696199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective Twin to twin transfusion syndrome (TTTS) complicates 5-15% of monochorionic twin pregnancies and untreated is associated with a 90% mortality rate. The aim was to present the perinatal survival of patients with TTTS treated with laser ablation, by a national fetal medicine team. Methods This was a review of all cases of TTTS treated with fetoscopic laser ablation performed from March 2006 through to December 2020. All patients treated with fetoscopic laser were identified from the hospital database. The perinatal outcomes for the overall cohort and the individual Quintero stages were determined. Results A total of 155 cases of TTTS underwent fetoscopic laser ablation during the study period. The median gestational age at diagnosis was 19+1 weeks, with a mean growth discordance of 23.6%. The Quintero stage at diagnosis was: Stage 1 6.5% (10/155), Stage 2 49% (76/155), Stage 3 38.7% (60/155), Stage 4 5.8% (9/155). There was at least one survivor in 83.2% (129/155) of pregnancies, with dual survival in 52.9% (82/155). An increase in the rate of any survivor was observed from 75% (2006-2014) to 94% (2014-2020) (p<0.05). Dual survival decreased with increasing Quintero Stage (p<0.05). 80.6% (125/155) of pregnancies delivered prior to 34+6 weeks gestation. Conclusion Fetoscopic laser ablation is the recommended first line treatment for severe TTTS. We observed a survival rate of at least one twin in 83.2% pregnancies which is comparable to internationally published data on single-centre outcomes.
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Affiliation(s)
- G A Ryan
- Department of Obstetrics and Gynaecology, The National Maternity Hospital, Dublin, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - C Finnegan
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - F M McAuliffe
- Department of Obstetrics and Gynaecology, The National Maternity Hospital, Dublin, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - F D Malone
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - S M Müllers
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
| | - S Corcoran
- Department of Obstetrics and Gynaecology, The National Maternity Hospital, Dublin, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - C Mulcahy
- Department of Obstetrics and Gynaecology, The National Maternity Hospital, Dublin, Ireland
| | - J Dalrymple
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
| | - J Donnelly
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
- UCD Obstetrics & Gynaecology, University College Dublin, Ireland
| | - J Walsh
- Department of Obstetrics and Gynaecology, The National Maternity Hospital, Dublin, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - P Mcparland
- Department of Obstetrics and Gynaecology, The National Maternity Hospital, Dublin, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - A Martin
- UCD Obstetrics & Gynaecology, University College Dublin, Ireland
- Department of Obstetrics and Gynaecology, The Coombe Women And Infants University Hospital, Dublin, Ireland
| | - S Carroll
- Department of Obstetrics and Gynaecology, The National Maternity Hospital, Dublin, Ireland
| | - E Kent
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
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