Perinatologist and twin expert, Dr. Larry Rand, describes the risks and advantages of placental laser ablation therapy, the most effective treatment for TTTS that has reached or exceeded stage 2. Expected long-term outcomes are also discussed.
Refer to Fetal Treatment Center
We've talked about the staging system for 20 twin transfusion and why that's so important to help us determine what the next best steps are to managing a complicated monta chorionic twin pregnancy. In our experience, the most important differentiation is whether you are still stage one or you've developed Stage two or worse disease. Stage One has a 50% chance of resolving and improving on its own stage to you suddenly have an 80 to 90% chance of losing both fetuses. There's a phenomenal difference between Stage one and Stage two, which is why we make a really big deal about differentiating between them. If you have Stage one disease will work really hard to try to find an A. Which gives us some reassurance that we expect things to remain relatively stable. If we can't find an A. A, that doesn't mean one isn't there? But to keep the twin safe, they'll need very close surveillance with ultrasound to either demonstrate that they remain stable or improve or to make sure that we catch it if they progressed to stage two or beyond with stage 2, 20 twin transfusion or worse. The best treatment option is laser ablation, fetus, coptic placental laser ablation is a procedure that involves inserting a three millimeter scope into the uterus and using the small camera that's embedded into that scope to find that one way a V connections and burn or oblate them. Using a laser laser definitely has risks though There is a 10-15% risk of something going wrong with the laser procedure. That risk does include breaking your water or going into labor or losing the pregnancy altogether. A 10-15% risk of something going wrong is pretty significant and we take that seriously. For comparison in amniocentesis is something that people generally really wring their hands about As long as you're having an uncomplicated pregnancy. Is it worth taking the risk associated with an amniocentesis? While that risk is one in 400 or.25 With laser, we're talking about 10-15% and that's a significant risk. But you're comparing that risk to an 80-90% chance of losing one or both of the fetuses and under those conditions and circumstances it's acceptable. Unfortunately. Although laser is the best treatment available for TTS, it's far from perfect. The likelihood that you'll end up with two surviving twins is only 65%. The likelihood of having at least one surviving fetus is 80-85%. Perhaps. Most importantly, infants who have had twin to twin and were treated with the laser and survive have up to an 11% chance of a long term neurologic injury. Two thirds of these injuries are pretty severe, like cerebral palsy and the other third are milder, including things like learning disabilities, developmental delay and milder cognitive deficiencies. The single greatest risk factor for having one of these neurologic injuries is being born at an early gestational age and unfortunately twins, especially monta cryonic twins, who've been complicated by T. T. T. S. And required laser therapy are at risk of being born early. However, laser can be successful and when it is the average gestational age for delivery is 35 weeks and that would be considered a fantastic outcome.
