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J Perinat Med. 1999;27(1):61-7.

Treating previable twin-twin transfusion syndrome with
fetoscopic laser surgery: outcomes following the learning curve.

De Lia JE, Kuhlmann RS, Lopez KP.

Department of Obstetrics and Gynecology, University of Illinois at Chicago, USA.

We have performed fetoscopic laser occlusion of chorioangiopagous vessels (FLOC) in previable pregnancies affected by twin-twin transfusion syndrome (TTTS) since 1988. Treatment outcomes obtained after
the procedure's learning curve are presented and
compared to those from other centers performing
FLOC or other treatment methods.

A total of 100 cases of FLOC have been performed at
our centers. The later 67 TTTS patients had a mean gestational age of 21.1 +/- 1.7 weeks (range 18-24.5)
with a mean fundal height of 33.1 +/- 4.9 cm
(range 27-44) when treated. Eighteen (27%)
had failed another treatment method before FLOC.

All 67 cases have delivered with 82% (55/67) having
at least one surviving twin and 93/134 (69%) of the twins surviving overall. Thirty-eight have surviving twins, 17
have one survivor (5 neonatal and 12 fetal deaths), and
12 have none. The mean duration of pregnancy following FLOC was 9.9 +/- 5.5 weeks (range 1.0-19). Only 4 of 93 (4.3%) survivors have significant handicaps at a mean follow-up of 14.3 +/- 10.1 months (range 1.0-34). CONCLUSION: Fetoscopic laser occlusion of chorioangiopagous vessels within the vascular equator
limits the duration of fetal pathophysiology in TTTS and results in neonatal outcomes superior to the modified procedure and other treatment methods.

PMID: 10343935 [PubMed - indexed for MEDLINE]

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