A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome.

A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome. Research Abstract Details 

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A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome. Abstract Text:

Timothy M Crombleholme,David Shera,Hanmin Lee,Mark Johnson,Mary D'Alton,Flint Porter,Jacquelyn Chyu,Richard Silver,Alfred Abuhamad,George Saade,Laurence Shields,David Kauffman,Joanne Stone,Craig T Albanese,Ray Bahado-Singh,Robert H Ball,Larissa Bilaniuk,Beverly Coleman,Diana Farmer,Vickie Feldstein,Michael R Harrison,Holly Hedrick,Jeffrey Livingston,Robert P Lorenz,David A Miller,Mary E Norton,William J Polzin,Julian N Robinson,Jack Rychik,Per L Sandberg,Istvan Seri,Erin Simon,Lynn L Simpson,Larisa Yedigarova,R Douglas Wilson,Bruce Young,

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.

A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome. Publishing Authors By Initials

TM Crombleholme,D Shera,H Lee,M Johnson,M D'Alton,F Porter,J Chyu,R Silver,A Abuhamad,G Saade,L Shields,D Kauffman,J Stone,CT Albanese,R Bahado-Singh,RH Ball,L Bilaniuk,B Coleman,D Farmer,V Feldstein,MR Harrison,H Hedrick,J Livingston,RP Lorenz,DA Miller,ME Norton,WJ Polzin,JN Robinson,J Rychik,PL Sandberg,I Seri,E Simon,LL Simpson,L Yedigarova,RD Wilson,B Young,

For similar reproductive and urinary physiology: reproduction: pregnancy: pregnancy, multiple: twins research abstracts see: reproductive and urinary physiology: reproduction: pregnancy: pregnancy, multiple: twins research

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A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome. Journal Published:

PUBLICATION TYPE: Research Support, N.I.H., Extr

Journal: American journal of obstetrics and gynecology

VOLUME: 197

Page Numbers: 396.e1-9

Journal Abbreviation: Am. J. Obstet. Gynecol.

ISSN: 1097-6868

DAY: 3

MONTH: Oct

YEAR: 2007

A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome. Information

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LANGUAGE: eng

NlmUniqueID: 370476

A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome. Keywords Mesh Terms:

KEYWORDS: Twins

MESH TERMS: methods

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Grant and Affiliation Information for A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome.

AFFILIATION: Fetal Care Center of Cincinnati, Division of Pediatric General, Thoracic, and Fetal Surgery, Cincinnati Children's Hospital, MLC #2023, 3333 Burnet Avenue, Cincinnati, OH 45229, USA. timothy.crombleholme@cchmc.org

Country: United States

AGENCY: United States NICHD

GRANT: R01 HD41149

ACRONYM: HD

MEDLINETA: Am J Obstet Gynecol

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