Rising Demand for Fetoscopic Laser Therapy for Twin-to-Twin Transfusion Syndrome: Trends, Maternal Age Insights, and Future Challenges in Germany.

The twin-to twin transfusion syndrome (TTTS) is the most common complication of monochorionic twin pregnancies. Fetal laser therapy (FLT) and serial amniondrainage (SAD) have been used as treatment options for TTTS. This study examines how the management of TTTS in Germany has evolved in the past years and addresses future patient needs and potential challenges for healthcare providers and healthcare systems. The number of TTTS-related interventions between the years 2005 and 2021 were extracted from the German Federal Statistical Office. The trajectory of FLT and SAD procedures over the study period was analyzed. The historical data were used to make projections for future years and address future FLT surgical needs. Further, we aimed to determine age-related influences in monochorionic twin pregnancies requiring FLT. A statistically significant increase in the number of FLT surgeries and a noteworthy decline in the number of SAD procedures with respect to both the number of deliveries per year and the number of multiple pregnancies per year were noted. For the first time, we showed that the percentage of multiple pregnancies requiring FLT was significantly higher in younger mothers under 25 years of age, than in all other age groups. For the moment, FLT poses the only direct and causative treatment of TTTS. The results of our analysis reveal an increasing demand for FLT surgeries for future years. We highlight the need to train more maternal-fetal medicine specialists to be able to perform the procedure safely and to allocate resources efficiently to accommodate the rising number of cases.