Selective vs complete fetoscopic coagulation of vascular equator: a matched comparative study
Raphael Bartin1, Claire Colmant1, Nicolas Bourgon1
1Department of Obstetrics and Maternal-Fetal Medicine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris and EA7328, Université de Paris, Paris, France.
American Journal of Obstetrics and Gynecology
|May 2, 2022
Summary
The Solomon technique for twin-twin transfusion syndrome significantly improves twin survival and reduces complications like twin anemia polycythemia syndrome. However, it increases the risk of preterm premature rupture of membranes.
Area of Science:
- Perinatology
- Maternal-Fetal Medicine
- Surgical Innovation
Background:
- Twin-twin transfusion syndrome (TTTS) poses significant risks to affected pregnancies.
- Fetoscopic laser coagulation of chorionic vessels is a primary treatment for TTTS.
- The Solomon technique, involving complete coagulation of the vascular equator, is proposed to enhance outcomes.
Purpose of the Study:
- To compare the perinatal outcomes of the Solomon technique versus selective ablation of anastomoses in TTTS treatment.
- To evaluate the efficacy of complete vascular equator coagulation in reducing TTTS-related complications.
Main Methods:
- A monocentric retrospective study comparing selective laser coagulation with the Solomon technique (January 2006 - August 2020).
- Propensity score matching was used to control for confounders like gestational age, placental location, and Quintero stage.
- Analysis included 399 matched pairs from a total of 994 cases.
Main Results:
- The Solomon technique demonstrated significantly improved overall twin survival at delivery (79% vs 72%) and discharge (75% vs 69%).
- Double twin survival at discharge was higher with the Solomon technique (65% vs 55%), and intrauterine death rates decreased (12% vs 18%).
- TTTS complications, including twin anemia polycythemia syndrome, were reduced, but preterm premature rupture of membranes increased, particularly before 24 weeks (11% vs 3.8%).
Conclusions:
- The Solomon technique significantly enhances perinatal outcomes in TTTS pregnancies.
- Despite an increased risk of preterm premature rupture of membranes, the benefits of the Solomon technique in improving survival and reducing complications outweigh this risk.
