[Analysis of clinical outcome and impact factors of twin-to-twin transfusion syndrome with anterior placenta treated by fetoscopic laser photocoagulation].

OBJECTIVE

To analyze the clinical outcome and impact factors of twin-to-twin transfusion syndrome (TTTS) with anterior placenta treated by fetoscopic selective laser coagulation of placental vessels (SLCPV).

METHODS

Ten cases of TTTS with anterior placenta and 8 cases with posterior placenta were treated by SLCPV in Shengjing Hospital from July 2011 to April 2014. Clinical data were analyzed retrospectively. Some cases were at Quintero stage II or higher stage, others were at Quintero stage I but with cardiovascular score ≥ 5 according to the scoring system of Children's Hospital of Philadelphia. The anterior placenta cases were treated by curve fetoscopy and the posterior placenta cases were treated by straight fetoscopy.

RESULTS

(1) Of all the 18 cases, the mean gestational age at SLCPV was 24.1 weeks (17(+5) to 27(+4) weeks). There were 2 cases at Quintero stage I, 4 at stage II and 12 at stage III. The mean gestational age of anterior placenta cases at SLCPV was 25.2 weeks (22 to 27(+4) weeks), with 2 cases at Quintero stage I, 2 cases at stage II and 6 at stage III; 5 cases had preterm prelabour rupture of the membranes (PPROM) and 1 case had maternal intestinal obstruction after the operation; the average operation time was 40 minutes. Of the posterior placenta cases, the mean gestational age at SLCPV was 22.7 weeks (17(+5) to 27(+4) weeks); 2 cases were at Quintero stage II and 6 cases at stage III. PPROM happened in one case; one case had maternal enterobacter cloacae septicemia; the average operation time was 28 minutes. All the 18 cases could tolerate the operations. There was no intraoperative complication. (2) One anterior placenta case had maternal intestinal obstruction and miscarriage; and one posterior placenta case had enterobacter cloacae septicemia. Karyotype analyses of the all the twins were normal. (3) 17 cases delivered already, including all the 10 anterior placenta cases and 7 posterior placenta cases. One infant had corpus callosum agenesis, but its co-twin was normal. The average gestational age at delivery for anterior placenta cases was 32.6 weeks (24 to 37(+1) weeks), an was 28.2 weeks (25(+6) to 36(+2) weeks) for posterior placenta cases. The fetuses survival rate was 13/17 (one case was still in pregnancy) for at least one twin, and 10/17 for both twins. Both twins survival rates were 5/10, 5/7 for anterior placenta cases and posterior placenta cases, respectively. At least one twin survival rates were 8/10, 5/7 for the two groups respectively.

CONCLUSION

SLCPV is suitable for the treatment of TTTS, no matter the placenta is on the anterior wall or posterior wall. The treatment had good outcomes, but more PPROM happened in the anterior placenta cases, which may be associated with operation time and the range of operation.