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SELECTIVE LASER PHOTOCOAGULATION OF COMMUNICATING VESSELS IN SEVERE TWIN–TWIN TRANSFUSION SYNDROME IN WOMEN WITH AN ANTERIOR PLACENTA

Quintero, Rubén A. MD; Bornick, Patricia W. RN, MSN; Allen, Mary H. RN; Johnson, Patricia K. RDMS

INSTRUMENTS & METHODS
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Background We describe two techniques for the laser treatment of twin–twin transfusion syndrome in women with anterior placentas.

Technique In the first technique, anastomoses were photocoagulated using a flexible endoscope through a single port. The second technique used a side-firing laser fiber with a rigid angled-view endoscope (two ports).

Experience Seventy-two women had surgery between July 1997 and December 1999, 35 (48.6%) of whom had anterior placentas. Survival was similar for fetuses with anterior (80%) and posterior (75.6%) placentas, but operating time was significantly longer for those with anterior placentas (81.1 compared with 64.4 minutes for the anterior and posterior placentas, respectively; P = .02, Student t test). At least one fetus survived in 76% (16 of 21) of women treated with flexible endoscopes and 86% (12 of 14) of those treated with the side-firing lasers. Six of 72 women (8.3%) had patent vascular anastomoses on placental examination, and five of them had anterior placentas (P = .08, Fisher exact test).

Conclusion Although anterior placentas are surgically more challenging than posterior placentas, both techniques allow an effective percutaneous approach to the laser treatment of twin–twin transfusion syndrome.

Two techniques are described for percutaneous laser treatment of twin-twin transfusion patients with anterior placentas.

Florida Institute for Fetal Diagnosis and Therapy, St. Joseph's Women's Hospital, Tampa, Florida.

Rubén A. Quintero, MD, Saint Joseph's Women's Hospital, 13601 Bruce B. Downs Boulevard, Suite 160, Tampa, FL 33613; E-mail: yvrq@aol.com

The authors thank Dr. Michael Gravens from the University of South Florida, College of Public Health, Tampa, and Mr. Michael Kruger from the Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, for their assistance with the statistical analysis.

Received July 20, 2000. Received in revised form September 22, 2000. Accepted October 5, 2000.

© 2001 The American College of Obstetricians and Gynecologists