Mutidiode laser photocoagulation of placental vessels in twin-to-twin transfusion syndrome

Objective. To describe the outcome of monochorionic twin pregnancies complicated by twin-twin transfusion syndrome, managed in a single perinatal centre and treated with multidiode laser photocoagulation of abnormal placental communicating vessels.Material and Methods. From November 2002 to July 2004, 12 patients diagnosed with twin-twin transfusion syndrome were treated with multidiode laser photocoagulation (14 procedures). Monochorionic twin pregnancies with severe polyhydramnios in the recipient twin and strong oligohydramnios in donor twin is the key diagnostic feature in this syndrome; once diagnosed, severity of the syndrome was established following the classification reported by Quintero and cols. After laser therapy was completed we evaluated survival rates and complications associated with therapy.Results. Selective laser photocoagulation of communicating vessels was performed in 12 patients (14 procedures). In all these cases, both laser treatment and amnioreduction were carried out. The average number of abnormal placental communicating vessels was eight and average surgery time was 25 minutes. No maternal post-surgery complications were observed but there was a preterm premature rupture of membranes which most probably could be the cause of the subsequent miscarriage. Fetal survival rate of at least one twin to 28 days of age was 70%, while the number of deaths was associated to: 7 intrauterine deaths after surgical procedure, 2 neonatal deaths after preterm delivery and 2 deaths caused by a miscarriage after preterm rupture of membranes.Discussion. Twin-twin transfusion syndrome is a heterogeneous disorder in its clinical expression and progression. Laser photocoagulation is an efficient treatment for this syndrome, its spread and application in other centres would allow early management of this disorder, decreasing the fetus/neonatal morbidity and mortality rate. In this study we have applied a selective technique using a multidiode laser with results similar to those obtained in other studies that have been reported, which are survival rates between 50 to 76%.