Endoscopic laser surgery versus serial amniocenteses in the treatment of severe twin-twin transfusion syndrome

OBJECTIVE: Severe twin-twin transfusion can be treated by either serial amn iocenteses with removal of targe volumes of amniotic fluid or by endoscopic laser coagulation of the communicating vessels. We investigated the benefi t of laser surgery in comparison to serial amniocenteses in terms of pregna ncy outcome. STUDY DESIGN: The data used in this comparative study were collected from 1 16 patients with severe twin-twin transfusion syndrome between 17 and 25 we eks' gestation. The patients were grouped according to the treatment center . The first group comprised 73 patients (median gestational age 20.7 weeks) treated in Hamburg by fetoscopic laser coagulation of the vascular placent al anastomoses between January 1995 and May 1997. The second group comprise d 43 patients (median gestational age 20.4 weeks), fulfilling identical dia gnostic criteria and treated in Bonn by serial amniocenteses between 1992 a nd 1996. RESULTS: The overall fetal survival rate was not significantly different (6 1%, 89/146, vs 51%, 44/86; P = .239). There was a significantly higher prop ortion of pregnancies with greater than or equal to 1 survivor in the laser -treated group (79%, 58/73, vs 60%, 26/43; P = .033). The number of cases w ith spontaneous intrauterine fetal death of both fetuses was significantly lower in the laser-treated group (3%, 2/73, vs 19%, 8/43; P = .003). The in cidence of abnormal ultrasonographic findings in the brain was significantl y lower among surviving neonates after laser surgery than after amniocentes es (6%, 5/89, vs 18%, 8/44; P = .03). For pregnancies with greater than or equal to 1 liveborn baby, a significantly longer interval between first int ervention and delivery (median 90 vs 72 days, P = .022) leading to a signif icantly higher gestational age at delivery (median 33.7 vs 30.7 weeks, P = .018) was observed for the laser-treated group. The birth weights of the do nor fetuses were significantly higher in the laser-treated group (median 17 50 vs 1145 g, P = .034), and a trend toward higher birth weight was also fo und for recipient fetuses (median 2000 vs 1560 g, P = .076). CONCLUSIONS: These findings indicate that endoscopic laser coagulation of p lacental vascular anastomoses offers a mo re effective alternative to seria l amniocenteses as a treatment of severe second-trimester twin-twin transfu sion syndrome.