Immediate outcome of twin–twin transfusion syndrome following selective laser photocoagulation of communicating vessels at the NSW Fetal Therapy Centre
Article first published online: 17 MAR 2010
© 2010 The Authors. Journal compilation © 2010 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
Australian and New Zealand Journal of Obstetrics and Gynaecology
Volume 50, Issue 2, pages 112–119, April 2010
How to Cite
MERIKI, N., SMOLENIEC, J., CHALLIS, D. and WELSH, A.W. (2010), Immediate outcome of twin–twin transfusion syndrome following selective laser photocoagulation of communicating vessels at the NSW Fetal Therapy Centre. Australian and New Zealand Journal of Obstetrics and Gynaecology, 50: 112–119. doi: 10.1111/j.1479-828X.2009.01127.x
- Issue published online: 13 APR 2010
- Article first published online: 17 MAR 2010
- Received 8 July 2009; accepted 29 November 2009.
- endoscopic laser coagulation;
- perinatal mortality and morbidity;
- twin–twin transfusion syndrome
Objective: To audit the outcome for laser photocoagulation for twin–twin transfusion syndrome (TTTS) as managed by the New South Wales Fetal Therapy Centre (NSW FTC).
Methods: A retrospective cohort study. Outcome data were reviewed for referrals between June 2003 and June 2008.The outcome measures included the severity of TTTS at presentation, delivery details (gestational age at delivery, birth weight and Apgar score at 5 min) and perinatal outcome (spontaneous miscarriage, premature rupture of membranes, intrauterine death, placental abruption and neonatal death).
Results: Seventy-nine patients were treated with laser therapy for stage I–IV TTTS (median stage III). Median gestational age at treatment was 20 weeks (range 16–25). Median gestational age at delivery was 32 weeks (range 24–40). Survival of at least one baby in this study was 90.7% (88.9% for anterior and 92.1% for posterior placenta), and of both babies was 60.0%. Median birth weight was 1788 g (range 490–3695). Median Apgar score was nine at 5 min. Three women required repeat laser treatment for persistent TTTS.
Conclusions: Selective laser photocoagulation of communicating vessels remains the treatment of choice for TTTS. Referrals to the NSW FTC have increased from five cases in the last half of 2003, to 18 cases in the first half of 2008. Local outcome figures at least equal any in the published international literature and support a continued policy of centralised care in Australia. A two-year follow-up study on neonatal outcome for survivors is underway.