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Crombleholme, Timothy M., MD; Shera, David, ScD; Lee, Hanmin, MD; Johnson, Mark, MD; D’Alton, Mary, MD; Porter, Flint, MD; Chyu, Jacquelyn, MD; Silver, Richard, MD; Abuhamad, Alfred, MD; Saade, George, MD; Shields, Laurence, MD; Kauffman, David, MD; Stone, Joanne, MD; Albanese, Craig T., MD; Bahado-Singh, Ray, MD; Ball, Robert H., MD; Bilaniuk, Larissa, MD; Coleman, Beverly, MD; Farmer, Diana, MD; Feldstein, Vickie, MD; Harrison, Michael R., MD; Hedrick, Holly, MD; Livingston, Jeffrey, MD; Lorenz, Robert P., MD; Miller, David A., MD; Norton, Mary E., MD; Polzin, William J., MD; Robinson, Julian N., MD; Rychik, Jack, MD; Sandberg, Per L., MD; Seri, Istvan, MD; Simon, Erin, MD; Simpson, Lynn L., MD; Yedigarova, Larisa, MD; Wilson, R. Douglas, MD; Young, Bruce, MD
American journal of obstetrics and gynecology, 10/2007, Letnik: 197, Številka: 4Journal Article
Objective The objective of the study was to examine the effect of selective fetoscopic laser photocoagulation (SFLP) vs serial amnioreduction (AR) on perinatal mortality in severe twin-twin transfusion syndrome (TTTS). Study Design This was a 5 year multicenter, prospective, randomized controlled trial. The primary outcome variable was 30 day postnatal survival of donors and recipients. Results There was no statistically significant difference in 30-day postnatal survival between SFLP or AR treatment for donors at 55% (11 of 20) vs 55% (11 of 20) ( P = 1.0, odds ratio OR 1, 95% confidence interval CI 0.242 to 4.14) or recipients at 30% (6 of 20) vs 45% (9 of 20) ( P = .51, OR 1.88, 95% CI 0.44 to 8.64). There was no difference in 30 day survival of 1 or both twins on a per-pregnancy basis between AR at 75% (15 of 20) and SFLP at 65% (13 of 20) ( P = .73, OR 1.62, 95% CI 0.34 to 8.09). Overall survival (newborns divided by the number of fetuses treated) was not statistically significant for AR at 60% (24 of 40) vs SFLP 45% (18 of 40) ( P = .18, OR 2.01, 95% CI 0.76 to 5.44). There was a statistically significant increase in fetal recipient mortality in the SFLP arm at 70% (14 of 20) vs the AR arm at 35% (7 of 20) ( P = .25, OR 5.31, 95% CI 1.19 to 27.6). This was offset by increased recipient neonatal mortality of 30% (6 of 20) in the AR arm. Echocardiographic abnormality in recipient twin Cardiovascular Profile Score is the most significant predictor of recipient mortality ( P = .055, OR 3.025/point) by logistic regression analysis. Conclusion The outcome of the trial did not conclusively determine whether AR or SFLP is a superior treatment modality. TTTS cardiomyopathy appears to be an important factor in recipient survival in TTTS.
