Fetoscopic laser photocoagulation for twin-to-twin transfusion syndrome treatment: initial experience in tertiary reference center in Brazil
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Objective To evaluate the initial maternal and perinatal outcomes of fetoscopic laser photocoagulation for the treatment oftwin-to-twin transfusion syndrome (TTTS) in a referral center in Brazil. Methods This prospective observational study analyzed 24 fetoscopic laser photocoagulation procedures at 18.26 weeks ofgestation. TTTS severity was determined using the Quintero classification. Blood vessels that crossed the interamnioticmembrane were nonselectively photocoagulated. The χ2 test and Mann-Whitney U test were used for the statisticalanalysis. Results The mean (±standard deviation) age of pregnant women, gestational age at surgery, surgical time, gestational age atbirth, and newborn weight were 32.2±4.1 years, 20.7±2.9 weeks, 51.8±16.7 minutes, 30.5±4.1 weeks, and 1,531.0±773.1g, respectively. Using the Quintero classification, there was a higher percentage of cases in stage III (54.2%), followedby stages IV (20.8%), II (16.7%), and I (8.3%). Ten (41.7%) donor fetuses died and 14 (58.3%) donor fetuses surviveduntil the end of gestation. Placental insertion location (anterior vs. posterior) did not affect the incidence of iatrogenicseptostomy, surface bleeding, and premature rupture of membranes until the end of gestation. The death rate ofdonor and recipient fetuses before 24th gestational week increased with severity of TTTS. Conclusion The maternal and perinatal outcomes resulting from the implementation of a new minimally invasive surgicaltechnique are in line with those obtained in major centers worldwide, considering the learning curves andinfrastructures.
Abstract
Objective To evaluate the initial maternal and perinatal outcomes of fetoscopic laser photocoagulation for the treatment oftwin-to-twin transfusion syndrome (TTTS) in a referral center in Brazil. Methods This prospective observational study analyzed 24 fetoscopic laser photocoagulation procedures at 18.26 weeks ofgestation. TTTS severity was determined using the Quintero classification. Blood vessels that crossed the interamnioticmembrane were nonselectively photocoagulated. The χ2 test and Mann-Whitney U test were used for the statisticalanalysis. Results The mean (±standard deviation) age of pregnant women, gestational age at surgery, surgical time, gestational age atbirth, and newborn weight were 32.2±4.1 years, 20.7±2.9 weeks, 51.8±16.7 minutes, 30.5±4.1 weeks, and 1,531.0±773.1g, respectively. Using the Quintero classification, there was a higher percentage of cases in stage III (54.2%), followedby stages IV (20.8%), II (16.7%), and I (8.3%). Ten (41.7%) donor fetuses died and 14 (58.3%) donor fetuses surviveduntil the end of gestation. Placental insertion location (anterior vs. posterior) did not affect the incidence of iatrogenicseptostomy, surface bleeding, and premature rupture of membranes until the end of gestation. The death rate ofdonor and recipient fetuses before 24th gestational week increased with severity of TTTS. Conclusion The maternal and perinatal outcomes resulting from the implementation of a new minimally invasive surgicaltechnique are in line with those obtained in major centers worldwide, considering the learning curves andinfrastructures.
참고문헌 (19)
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