Twin-twin transfusion syndrome and fetal medicine centers

摘要

We enjoyed reading the Editorial by Jan Deprests* group from Leuven in Belgium on laser treatment for TTTS. Although we agree with most of their statements, and that there is obvious room for further improvements, we would like to stress that an inherent problem, when comparing results from different institutions, is the selection of cases on whiclr to operate. So far there are no population-based studies, and these are urgently needed to evaluate this procedure.Obviously, laser treatment cannot be realized in all fetal medicine centers, and certain resources need to be available. The different components listed in the Editorial such as 24-hour/7-day service, state-of-the-art equipment, specialist midwives, social workers, psychologiss and exceEent perinatal pathology are all at hand in Stockholm. We do agree that outcome should be provided on a long-term basis, and all cases treated in our program are included in an ambitious long-term follow-up of cardiovascular function and neurodevelopment.The number of cases needed to ensure an adequate training is an open question. We agree that our numbers need to be increased. At present we have had a 20% increase in the number of cases each year and three senior consultants are involved in the surgical procedures. We anticipate an increased number of cases after the decision by the Swedish National Board of Health and Welfare that from 2013 all fetal treatment procedures in our country are centralized to our unit. Furthermore, we are experiencing an increasing number of referrals from other countries, and this is of course reassuring for the future.