A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome.

Published

Journal Article

The objective of the study was to examine the effect of selective fetoscopic laser photocoagulation (SFLP) vs serial amnioreduction (AR) on perinatal mortality in severe twin-twin transfusion syndrome (TTTS).This was a 5 year multicenter, prospective, randomized controlled trial. The primary outcome variable was 30 day postnatal survival of donors and recipients.There was no statistically significant difference in 30-day postnatal survival between SFLP or AR treatment for donors at 55% (11 of 20) vs 55% (11 of 20) (P = 1.0, odds ratio [OR] 1, 95% confidence interval [CI] 0.242 to 4.14) or recipients at 30% (6 of 20) vs 45% (9 of 20) (P = .51, OR 1.88, 95% CI 0.44 to 8.64). There was no difference in 30 day survival of 1 or both twins on a per-pregnancy basis between AR at 75% (15 of 20) and SFLP at 65% (13 of 20) (P = .73, OR 1.62, 95% CI 0.34 to 8.09). Overall survival (newborns divided by the number of fetuses treated) was not statistically significant for AR at 60% (24 of 40) vs SFLP 45% (18 of 40) (P = .18, OR 2.01, 95% CI 0.76 to 5.44). There was a statistically significant increase in fetal recipient mortality in the SFLP arm at 70% (14 of 20) vs the AR arm at 35% (7 of 20) (P = .25, OR 5.31, 95% CI 1.19 to 27.6). This was offset by increased recipient neonatal mortality of 30% (6 of 20) in the AR arm. Echocardiographic abnormality in recipient twin Cardiovascular Profile Score is the most significant predictor of recipient mortality (P = .055, OR 3.025/point) by logistic regression analysis.The outcome of the trial did not conclusively determine whether AR or SFLP is a superior treatment modality. TTTS cardiomyopathy appears to be an important factor in recipient survival in TTTS.

Full Text

Cited Authors

  • Crombleholme, TM; Shera, D; Lee, H; Johnson, M; D'Alton, M; Porter, F; Chyu, J; Silver, R; Abuhamad, A; Saade, G; Shields, L; Kauffman, D; Stone, J; Albanese, CT; Bahado-Singh, R; Ball, RH; Bilaniuk, L; Coleman, B; Farmer, D; Feldstein, V; Harrison, MR; Hedrick, H; Livingston, J; Lorenz, RP; Miller, DA; Norton, ME; Polzin, WJ; Robinson, JN; Rychik, J; Sandberg, PL; Seri, I; Simon, E; Simpson, LL; Yedigarova, L; Wilson, RD; Young, B

Published Date

  • October 2007

Published In

Volume / Issue

  • 197 / 4

Start / End Page

  • 396.e1 - 396.e9

PubMed ID

  • 17904975

Pubmed Central ID

  • 17904975

Electronic International Standard Serial Number (EISSN)

  • 1097-6868

International Standard Serial Number (ISSN)

  • 0002-9378

Digital Object Identifier (DOI)

  • 10.1016/j.ajog.2007.07.020

Language

  • eng