P12.23: Outcome of 21 twin gestations after selective feticide of one malformed fetus in the second trimester of pregnancy

Objective: To report our initial experience with selective laser photocoagulation of the placental communicating vessels (SLPCV) in the treatment of severe mid trimester twin-to-twin transfusion syndrome (TTTS). Methodology: Eight cases of severe TTTS (6 monochorionic diamniotic twins and 2 dichorionic triamniotic triplets) diagnosed before the 26th week of gestation were managed by SLPCV, as Quintero reported in 1998, from November 2003 to February 2004. A 2 mm fetoscope and 600 ?m diode laser fibers were used through a 3 mm sheath inserted by ultrasound guidance. All procedures were performed under local anaesthesia. Main outcome items were perinatal survival and neurological morbidity up to the 28th day of postnatal life. Results: The median gestational age at laser was 20.3 weeks (range 18.2–24.5). 4 placentas were posterior and 4 were anterior, with a median number of 5 placental anastomoses (range 4–7). A median of 2175 ml (range 1500–4500) of amniotic fluid was drained, and the median time for performing the whole procedure, skin to skin, was 45 minutes (range 30–60). The overall survival rate was 66.7% (12/18), 2 (or 3) fetuses survived in 50% (4/8), and at least 1 fetus survived in 87.5% (7/8) of the cases. Excluding the case that miscarried at 24 hours after the procedure, the median gestational age at delivery was 30.5 weeks (range 27.1–35.5), with a median (range) weight of 1236 (675–2170) and 1359 (814–2280) grams for the donor and the recipient respectively. No single case of major brain damage was detected among the survivors up to the first month of life, as assessed either by clinical examination or by imaging techniques. Conclusion: Our initial results doing SLPCV in TTTS are comparable with those reported by others. Strict follow-up of children’s neurodevelopmental function is warranted, as we are aware that some neurologic deficiencies may not be evident at first month of life yet.)