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The Journal of Maternal-Fetal & Neonatal Medicine Volume 35, 2022 - Issue 26
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Research Article

Fetoscopic laser surgery for twin-to-twin transfusion syndrome in DCTA triplets compared to MCDA twins: collaborative study and literature review

Hiba J. Mustafaa Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USAORCID Iconhttps://orcid.org/0000-0002-5611-1231
ORCID Icon,
Ali Javinanib Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children’s Fetal Center, Houston, Texas, USA
,
Eyal Krispinb Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children’s Fetal Center, Houston, Texas, USA
,
Hooman Tadbiria Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USAORCID Iconhttps://orcid.org/0000-0002-2995-9181
ORCID Icon,
Jimmy Espinozab Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children’s Fetal Center, Houston, Texas, USA
,
Alireza A. Shamshirsazb Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children’s Fetal Center, Houston, Texas, USA
,
Ahmed A. Nassrb Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children’s Fetal Center, Houston, Texas, USA
,
Roopali Donepudib Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children’s Fetal Center, Houston, Texas, USA
,
Michael A. Belfortb Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children’s Fetal Center, Houston, Texas, USA
,
Magdalena Sanz Cortesb Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children’s Fetal Center, Houston, Texas, USA
,
Christopher Harmana Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
&
Ozhan M. Turana Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USACorrespondence[email protected]
 show all
Pages 10348-10354 | Received 04 Feb 2022, Accepted 06 Sep 2022, Published online: 18 Dec 2022
 
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Abstract

Objective

To compare the outcomes of dichorionic triamniotic (DCTA) triplets with that of monochorionic diamniotic (MCDA) twin gestations undergoing fetoscopic laser surgery (FLS) for treatment of twin-to-twin transfusion syndrome (TTTS).

Methods

Retrospective cohort study of prospectively collected data of consecutive DCTA triplet and MCDA twin pregnancies with TTTS that underwent FLS at two fetal treatment centers between 2012 and 2020. Preoperative, operative and, postoperative variables were collected. Perinatal outcomes were investigated. Primary outcome was survival to birth and to neonatal period. Secondary outcomes were gestational age (GA) at birth and procedure-to-delivery interval. Literature review was conducted in which PubMed, Web of Science, and Scopus were searched from inception to September, 2020.

Results

Twenty four sets of DCTA triplets were compared to MCDA twins during the study period. There were no significant differences in survival (no survivor, single, or double survivors) to birth and to the neonatal period of the MC twin pairs of the DCTA triplets vs MCDA twins. Median GA at delivery was approximately three weeks earlier in DCTA triplets compared to MCDA twins (28.4 weeks vs 31.4 weeks, p = .035, respectively). Rates of preterm birth (PTB) less than 32 and less than 28 weeks were significantly higher in DCTA triplets compared to twins (<32 weeks: 70.8% vs 51.1%, p = .037, respectively, and <28 weeks: 37.5% vs 20.8%, p = .033, respectively).

Conclusion

Perinatal survival including fetal and neonatal are comparable between DCTA triplets and MCDA twins. However, this might have resulted from the small sample size of the DCTA triplets. GA at delivery is earlier in triplets, which could be due to the nature of triplet gestation rather than to the laser procedure itself.

Disclosure statement

No potential conflict of interest was reported by the author(s).

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