Article Text

DOES FETOSCOPIC LASER SURGERY FOR TWIN-TO-TWIN TRANSFUSION SYNDROME IMPROVE NEONATAL OUTCOME OF PRETERM TWINS?
  1. M Kesiak1,
  2. E Lerch1,
  3. B Pawlowska1,
  4. K Szaflik3,
  5. P Nowak3,
  6. E M Gulczynska1,2
  1. 1Department of Neonatology, Research Institute of Polish Mother's Memorial Hospital, Lodz, Poland
  2. 2Department of Neonatology, Medical University, Lodz, Poland
  3. 3Department of Gynaecology and Fertility, Research Institute of Polish Mother’s Memorial Hospital, Lodz, Poland

Abstract

Objective Twin-to-twin transfusion syndrome (TTTS) results in high rates of perinatal mortality and morbidity. Fetoscopic laser surgery (FLS) is currently used as the treatment of choice for advanced disease. The purpose of this study was to evaluate neonatal outcome after TTTS that was treated by FLS compared to the group without FLS.

Methods We took retrospective analysis of all neonates live born from pregnancies with TTTS in our tertiary hospital from 2005 to February 2008. Neonatal outcome was assessed in 48 newborns who were treated with FLS (n = 20) and compared with the group without FLS (n = 28); in that group 18 neonates were without any antenatal treatment and 10 were treated with amnioreduction. We evaluated neonatal mortality and serious morbidity. Donors and recipients were assessed separately.

Results The average BW of donor was 874 g (FLS) and 829 g (without FLS); recipients average BW was 1320 g and 1387 g respectively. Neonatal mortality was higher among the donors (52%) then recipients (36%). There was no statistically significant difference in mortality (donors: 55.6% in FLS group and 50.0% in no FLS group, recipients: 36.4% and 35.7% respectively). In the FLS group serious neurologic morbidity occurred less often (15%) compared with the no FLS group (32%) especially among recipients (18.2% vs 42.9%). Recipients survival without severe cerebral lesions was higher in FLS group (63.6%) compared with the no FLS group (28.6%) (p<0.05).

Conclusions FLS has no effect on preterm twins mortality, but improves neurological outcome particularly among recipients.

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