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Endoscopic Laser Surgery versus Serial Amnioreduction for Severe Twin-to-Twin Transfusion Syndrome
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Endoscopic Laser Surgery versus Serial Amnioreduction for Severe Twin-to-Twin Transfusion Syndrome
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Journal Article
Endoscopic Laser Surgery versus Serial Amnioreduction for Severe Twin-to-Twin Transfusion Syndrome
2004
Overview
In a randomized trial of women with severe twin-to-twin transfusion syndrome during midgestation, fetoscopic laser therapy (coagulation of placental vascular anastomoses) resulted in significantly higher survival rates of at least one twin and lower rates of neurologic abnormalities at six months of age than did amnioreduction (repeated removal of large volumes of amniotic fluid).
As compared with serial amnioreduction, endoscopic laser ablation of anastomoses may improve outcomes.
Monochorionic twin pregnancies complicated by severe twin-to-twin transfusion syndrome
1
before 26 weeks of gestation are associated with high risks of fetal loss, perinatal death, and subsequent handicap in the survivors.
2
–
5
The prognosis for untreated severe twin-to-twin transfusion syndrome is dismal,
6
with perinatal mortality rates of up to 90 percent.
7
The optimal initial treatment of this complication remains controversial. Uncontrolled series have suggested that two approaches reduce mortality. Serial amnioreduction is widely available and involves the repetitive removal of large volumes of amniotic fluid. The rationale for this technique is to prevent preterm delivery related to polyhydramnios and to improve . . .
Publisher
Massachusetts Medical Society
Subject
