Immediate outcome of twin-twin transfusion syndrome following selective laser photocoagulation of communicating vessels at the NSW Fetal Therapy Centre.

OBJECTIVE

To audit the outcome for laser photocoagulation for twin-twin transfusion syndrome (TTTS) as managed by the New South Wales Fetal Therapy Centre (NSW FTC).

METHODS

A retrospective cohort study. Outcome data were reviewed for referrals between June 2003 and June 2008.The outcome measures included the severity of TTTS at presentation, delivery details (gestational age at delivery, birth weight and Apgar score at 5 min) and perinatal outcome (spontaneous miscarriage, premature rupture of membranes, intrauterine death, placental abruption and neonatal death).

RESULTS

Seventy-nine patients were treated with laser therapy for stage I-IV TTTS (median stage III). Median gestational age at treatment was 20 weeks (range 16-25). Median gestational age at delivery was 32 weeks (range 24-40). Survival of at least one baby in this study was 90.7% (88.9% for anterior and 92.1% for posterior placenta), and of both babies was 60.0%. Median birth weight was 1788 g (range 490-3695). Median Apgar score was nine at 5 min. Three women required repeat laser treatment for persistent TTTS.

CONCLUSIONS

Selective laser photocoagulation of communicating vessels remains the treatment of choice for TTTS. Referrals to the NSW FTC have increased from five cases in the last half of 2003, to 18 cases in the first half of 2008. Local outcome figures at least equal any in the published international literature and support a continued policy of centralised care in Australia. A two-year follow-up study on neonatal outcome for survivors is underway.