Fetoscopic Laser Therapy for Twin-Twin Transfusion Syndrome: Beyond Current Gestational Age Limits

摘要

Monochorionic diamniotic (MC/DA) twins share a single placenta, which can lead to specific complications, including twin-twin transfusion syndrome (TTTS), twin anemia-poly-cythemia sequence (TAPS), and selective intrauterine growth restriction (sIUGR).1 TTTS results from unbalanced blood flow from the donor to the recipient twin through placental vascular anastomoses. Oligo/anhydramnios and polyhydram-nios develop in the hypovolemic, oliguric donor and the hypervolemic, polyuric recipient twins, respectively. Expectant management is associated with a mortality rate > 90%, and neurodevelopment impairment in 30% of survivors.The first line therapy for severe TTTS is fetoscopic laser ablation of the placental anastomoses, with survival rates of approximately 90% for at least one twin and 70% for both.