ENDOSCOPIC LASER COAGULATION IN THE MANAGEMENT OF SEVERE TWIN-TO-TWINTRANSFUSION SYNDROME

Objective To assess the clinical effectiveness of endoscopic laser coa gulation of placental vessels in the treatment of severe transfusion s yndrome. Design Prospective study. Setting Three referral centres for the management of twin-to-twin transfusion syndrome. Population One hu ndred and thirty-two pregnancies complicated by severe twin-to-twin tr ansfusion syndrome, reflected by polyhydramnios and enlarged bladder o f one twin and oligoanhydramnios and collapsed bladder of the other tw in, presenting before 28 weeks of gestation. Methods Prospective colle ction of data on pre-procedure assessment, the procedure and the follo w up were collected prospectively. Laser coagulation of placental vess els crossing the intertwin membrane on the chorionic surface under son o-endoscopic guidance, followed by amniodrainage. Main outcome measure s Maternal and pregnancy complications, perinatal death and morbidity were assessed over the last five years with follow up of survivors. Re sults Endoscopic laser was carried out at a median gestation of 21 wee ks. The total number of surviving infants was 144 (55%) and there was at least one survivor in 97 cases (73%). At a minimum age of one year neurological handicap was suspected in six survivors (4.2%). Conclusio ns The results of this multicentre study are similar to those in our o riginal report on the first 45 cases. In comparison with serial amniod rainage, the survival rate may be similar, but the handicap rate in su rvivors appears much lower. This study stresses the need for a prospec tive study comparing these two techniques.