Interventions for twin-twin transfusion syndrome: a Cochrane review.
1Department of Obstetrics and Gynaecology, Liverpool Women's NHS Foundation Trust, Liverpool, UK. Devender.Roberts@lwh.nhs.uk
Summary
Laser coagulation is a more effective treatment for twin-twin transfusion syndrome (TTTS) than amnioreduction, significantly reducing overall, perinatal, and neonatal deaths. This method also improves the rate of babies surviving without neurological abnormalities by six months.
Area of Science:
- Maternal-Fetal Medicine
- Neonatalogy
- Evidence-Based Medicine
Background:
- Twin-twin transfusion syndrome (TTTS) is a serious complication of monochorionic twin pregnancies.
- Effective treatment strategies are crucial for improving outcomes in affected fetuses and neonates.
- Previous reviews have assessed various interventions, but updated data is needed.
Purpose of the Study:
- To conduct a Cochrane review comparing amnioreduction, laser coagulation, and septostomy for twin-twin transfusion syndrome (TTTS).
- To assess the impact of these treatments on fetal, childhood, and maternal outcomes.
- To provide an updated evidence-based summary of treatment efficacy.
Main Methods:
- Systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
- Searched Cochrane Pregnancy and Childbirth Group's Trials Register and Cochrane Central Register of Controlled Trials.
- Included three studies with 253 women, analyzing outcomes such as mortality and neurological abnormality.
Main Results:
- Laser coagulation showed reduced overall death (RR 0.81) and perinatal death (RR 0.59) compared to amnioreduction.
- Neonatal death was significantly lower with laser coagulation (RR 0.29) versus amnioreduction.
- More infants in the laser group survived without neurological abnormality at 6 months (RR 1.66) compared to amnioreduction.
Conclusions:
- Endoscopic laser coagulation of anastomotic vessels is recommended for treating all stages of TTTS.
- Laser coagulation improves perinatal and neonatal outcomes, including survival without neurological impairment.
- No significant difference in perinatal outcomes was observed between amnioreduction and septostomy.
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