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396: Twin-to-twin transfusion syndrome: a comparison of combined amnioreduction/laser surgery to laser surgery alone

      Objective

      A National Institutes of Health randomized clinical trial showed no difference in outcomes in twin-twin transfusion syndrome when comparing amnioreduction and laser therapy preceded by a “test amniocentesis”. The purpose of our study was to compare the perinatal outcomes of TTTS patients treated with laser therapy only to those treated by a combination of a “test amniocentesis” followed by laser therapy.

      Study Design

      We compared outcomes for TTTS patients who underwent laser coagulation using the same enrollment criteria as those of the NIH trial: cervix >2 cm in length, no prior amniocentesis in either laser group, and no prior cerclage.

      Results

      See Table.
      Tabled 1
      NIH TrialUS FetusP1P2
      ARLaserLaserNIH-AR vs. US Fetus LaserNIH Laser vs. US Fetus Laser
      Recipient Survive10/21 (48%)6/21 (30%)184/232 (76%)0.002<0.001
      Donor Survive12/21 (55%)12/21 (55%)193/230 (80%)0.0050.006
      One/Both Survive16/21 (75%)14/21 (65%)218/241 (91%)0.0580.005
      Overall (per fetus)26/42 (60%)18/42 (43%)373/482 (77%)0.02<0.001
      Recipient Stage III&IVN=? (67%)N=? (13%)90/127 (70%)N/AN/A

      Conclusion

      Based on our data, we conclude that patients who need treatment for TTTS should undergo laser therapy as the primary treatment modality and no prior amniocentesis.