[INTRODUCTION OF ENDOSCOPIC LASER THERAPY FOR COMPLICATED MONOCHORIONIC TWINS IN BULGARIA]
Objective:
The aim of this study is to describe our initial experience of endoscopic laser coagulation of inter-twin placental vessels in the treatment for severe twin-to-twin transfusion syndrome (TTTS) and selective fetal growth restriction (sFGR) at SABBAL "Dr Shterev Hospiat".
Methods:
Endoscopic laser surgery was carried out in eight cases of TTTS and two cases of sFGR at a median gestational age of 21.4 (range 16.4-23.1) weeks. In the group of TTTS there was one, three and four cases of Quintero stage 2, 3 and 4, respectively. Both cases of sFGR were Gratacos type 2.
Results:
In the eight cases of TTTS, there was survival of both twins in four cases (one, two and one of Quintero stages 2, 3 and 4, respectively), survival of one twin in one case (Quintero stage 3) and death of both twins in three cases (all Quintero stage 4). In the sFGR group, both twins survived in one case and one survived in one case. The three cases of TTTS with death of both twins were in the first four cases of the series and the death occurred during or within 24 hours of the procedure where in 2 cases there was SROM with cervical length 7 and 12 mm respectively. In the seven cases with survivors, the median gestational age at delivery was 32.3 (range 28.1-37.0) weeks.
Conclusions:
Our results from endoscopic surgery in TTTS and sFGR are encouraging and are likely to improve with increasing experience. There was at least one survivor in two of the first four cases and in all six subsequent cases.
