[INTRODUCTION OF ENDOSCOPIC LASER THERAPY FOR COMPLICATED MONOCHORIONIC TWINS IN BULGARIA]

Area of Science:

• Maternal-Fetal Medicine
• Minimally Invasive Surgery
• Perinatal Outcomes

Background:

• Twin-to-twin transfusion syndrome (TTTS) and selective fetal growth restriction (sFGR) are severe conditions requiring timely intervention.
• Endoscopic laser coagulation offers a minimally invasive approach to manage placental vascular anastomoses in these high-risk pregnancies.

Observation:

• The study details the initial experience with endoscopic laser coagulation in 10 pregnancies (8 TTTS, 2 sFGR) at a median gestational age of 21.4 weeks.
• TTTS cases included Quintero stages 2, 3, and 4; sFGR cases were Gratacos type 2.
• Early cases had higher rates of non-survival, particularly in severe TTTS (Quintero stage 4).

Findings:

• In TTTS cases, survival of both twins occurred in 50% (4/8), one twin in 12.5% (1/8), and both non-survived in 37.5% (3/8).
• In sFGR cases, one or both twins survived in all cases (2/2).
• Survival rates improved significantly with experience, with at least one survivor in all six cases after the initial four.

Implications:

• Endoscopic laser coagulation is a viable and effective treatment for severe TTTS and sFGR.
• Increasing surgical experience is associated with improved perinatal outcomes.
• This technique offers a promising option for improving survival in complicated monochorionic twin pregnancies.