Selective versus non-selective laser photocoagulation of placental vessels in twin-to-twin transfusion syndrome

R. A. Quintero, C. Comas, P. W. Bornick, M. H. Allen, M. Kruger

Research output: Contribution to journalArticle

160 Citations (Scopus)

Abstract

Objective: We have recently described a surgical technique for the treatment of twin-to-twin transfusion syndrome (TTTS) that allows precise identification of vascular anastomoses (selective laser photocoagulation of communicating vessels, or S-LPCV). The purpose of this study was to compare S-LPCV with the previous non-selective technique (NS-LPCV) that targeted all vessels crossing the dividing membrane. Materials and Methods: Patients with TTTS were treated with NS-LPCV from May 1994 to June 1997 and with S-LPCV from July 1997 to December 1999. TTTS was defined as polyhydramnios of ≥ 8 cm maximum vertical pocket (MVP) in the recipient twin and oligohydramnios of ≤ cm MVP in the donor twin. Outcome was measured as survival per number of pregnancies and per number of fetuses together with limited morbidity data. Results: NS-LPCV was used in 18 patients and 74 were treated with S-LPCV. Three patients interrupted their pregnancies electively after surgery (S-LPCV) and were removed from further analysis. Survival of at least one fetus was higher in S-LPCV (83.1%) than in NS-LPCV (61.1%) (P = 0.04), mostly due to a lower rate of dual intra-uterine fetal demise in S-LPCV (5.6%) than in NS-LPCV (22%) (P = 0.05). There were more hydropic fetuses in the NS-LPCV group (27%) than in the S-LPCV group (5.4%), but this difference did not account for the results. There was no difference in the survival per number of fetuses between the two groups. Conclusions: S-LPCV represents an important evolution in the surgical treatment of TTTS. The use of this technique by all centers should allow better comparison of fetal survival and morbidity rates. S-LPCV should be the standard technique in trials comparing amniocentesis versus laser for the treatment of severe TTTS.

Original languageEnglish
Pages (from-to)230-236
Number of pages7
JournalUltrasound in Obstetrics and Gynecology
Volume16
Issue number3
DOIs
StatePublished - Dec 1 2000

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transfusion
Fetofetal Transfusion
Light Coagulation
fetuses
vessels
Lasers
Fetus
pregnancy
lasers
Survival
Oligohydramnios
Morbidity
Polyhydramnios
Pregnancy
communicating
Fetal Death
Amniocentesis
surgery
Blood Vessels
Edema

Keywords

  • Amniocentesis
  • Communicating vessels
  • Fetal therapy
  • Fetoscopy
  • Laser photocoagulation
  • Twin-to-twin transfusion syndrome
  • Ultrasound

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology
  • Reproductive Medicine
  • Acoustics and Ultrasonics

Cite this

Selective versus non-selective laser photocoagulation of placental vessels in twin-to-twin transfusion syndrome. / Quintero, R. A.; Comas, C.; Bornick, P. W.; Allen, M. H.; Kruger, M.

In: Ultrasound in Obstetrics and Gynecology, Vol. 16, No. 3, 01.12.2000, p. 230-236.

Research output: Contribution to journalArticle

Quintero, R. A. ; Comas, C. ; Bornick, P. W. ; Allen, M. H. ; Kruger, M. / Selective versus non-selective laser photocoagulation of placental vessels in twin-to-twin transfusion syndrome. In: Ultrasound in Obstetrics and Gynecology. 2000 ; Vol. 16, No. 3. pp. 230-236.
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abstract = "Objective: We have recently described a surgical technique for the treatment of twin-to-twin transfusion syndrome (TTTS) that allows precise identification of vascular anastomoses (selective laser photocoagulation of communicating vessels, or S-LPCV). The purpose of this study was to compare S-LPCV with the previous non-selective technique (NS-LPCV) that targeted all vessels crossing the dividing membrane. Materials and Methods: Patients with TTTS were treated with NS-LPCV from May 1994 to June 1997 and with S-LPCV from July 1997 to December 1999. TTTS was defined as polyhydramnios of ≥ 8 cm maximum vertical pocket (MVP) in the recipient twin and oligohydramnios of ≤ cm MVP in the donor twin. Outcome was measured as survival per number of pregnancies and per number of fetuses together with limited morbidity data. Results: NS-LPCV was used in 18 patients and 74 were treated with S-LPCV. Three patients interrupted their pregnancies electively after surgery (S-LPCV) and were removed from further analysis. Survival of at least one fetus was higher in S-LPCV (83.1{\%}) than in NS-LPCV (61.1{\%}) (P = 0.04), mostly due to a lower rate of dual intra-uterine fetal demise in S-LPCV (5.6{\%}) than in NS-LPCV (22{\%}) (P = 0.05). There were more hydropic fetuses in the NS-LPCV group (27{\%}) than in the S-LPCV group (5.4{\%}), but this difference did not account for the results. There was no difference in the survival per number of fetuses between the two groups. Conclusions: S-LPCV represents an important evolution in the surgical treatment of TTTS. The use of this technique by all centers should allow better comparison of fetal survival and morbidity rates. S-LPCV should be the standard technique in trials comparing amniocentesis versus laser for the treatment of severe TTTS.",
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AU - Kruger, M.

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