Department of Obstetrics and Gynecology, Spedali Civili, Brescia, Italy.
Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
J Perinat Med. 2021 Sep 15;50(1):34-41. doi: 10.1515/jpm-2021-0058. Print 2022 Jan 27.
To review experience with fetoscopic laser ablation of placental anastomoses to treat monochorionic diamniotic (MCDA) twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) in a single centre over a ten-year period.
A retrospective study on 142 MCDA twin pregnancies complicates by TTTS treated with equatorial laser ablation of placental anastomoses (2008-2018). Solomon technique was also applied after 2013. Survival rates, neonatal outcome, intraoperative and post-laser complications were recorded, and prognostic factors analysed.
A total of 133 cases were included in the final analysis; 41 patients were at stage II (30.8%), 73 were at stage III (62.9%), while only 12 (9%) at stage I and two patients (1.7%) at stage IV. Solomon technique was applied in 39 cases (29.3%). Survival of both twins was 51.1% (68/133), of a single twin 20.3% (27/133), and of at least one 71.5% (95/133), with an overall survival of 61.3% (163/266). TAPS and recurrent TTTS occurred in 8 (6%) and 15 (11.3%) patients. Survival of both fetuses increased over time (44.6 vs. 57.3%). A posterior placenta (p<0.003) and the use of the Solomon technique (p<0.02) were more frequent in cases with survival of both fetuses, while TTTS recurrence was significantly associated to the loss of one or two fetuses (p<0.01). Such associations were confirmed at logistic regression analysis.
Survival of both twins can improve over time and seems to be favourably associated with a placenta in the posterior location and the use of the Solomon technique.
回顾在一家中心十年期间使用胎儿镜激光消融胎盘吻合术治疗合并双胎输血综合征（TTTS）的单绒毛膜双羊膜（MCDA）双胎妊娠的经验。
对 2008 年至 2018 年间接受胎盘吻合处赤道激光消融术治疗的 142 例合并 TTTS 的 MCDA 双胎妊娠进行回顾性研究。2013 年后还应用了 Solomon 技术。记录存活率、新生儿结局、术中及激光后并发症，并分析预后因素。
最终分析共纳入 133 例病例；41 例（30.8%）处于 2 期，73 例（62.9%）处于 3 期，仅 12 例（9%）处于 1 期，2 例（1.7%）处于 4 期。39 例（29.3%）应用了 Solomon 技术。双胎存活 51.1%（68/133），单胎存活 20.3%（27/133），至少存活 1 个胎儿的存活率为 71.5%（95/133），总体存活率为 61.3%（163/266）。TAPS 和复发性 TTTS 分别发生在 8 例（6%）和 15 例（11.3%）患者中。随着时间的推移，双胎存活率增加（44.6%比 57.3%）。在后胎盘（p<0.003）和使用 Solomon 技术（p<0.02）的病例中，双胎存活率更高，而 TTTS 复发与一个或两个胎儿丢失显著相关（p<0.01）。这种关联在逻辑回归分析中得到了证实。
双胎存活率随时间推移而提高，且似乎与胎盘位于后位和使用 Solomon 技术有关。
