Neurodevelopmental outcome and risk factors for disability for twin-twin transfusion syndrome treated with laser surgery

Monochorionic pregnancies are characterized by a single placenta shared by the twin fetuses. Twin-twin transfusion syndrome (TTTS) occurs in up to 15% of such pregnancies and results from unbalanced blood flow between the twins through placental vascular anastomoses. There is a high rate of fetal death and of neurodevelopmental disability among long-term survivors. Although serial amnioreduction improves survival in severe TTTS, it has little effect on the underlying transfusion process and does not prevent development of major neurodevelopmental disability in survivors. Fetoscopic laser ablation, in contrast, interrupts blood flow between the fetuses and has the potential to prevent neurologic injury and reduce neurodevelopmental disability among survivors. The use of fetoscopic laser ablation has been associated with better overall outcomes when compared with amnioreduction, and some investigators have suggested that it is the preferred treatment. Many studies have reported lower rates of cerebral palsy (CP) and neurodevelopmental disability in long-term survivors after laser surgery, but few studies have examined these outcomes in detail.