Neonatal outcome in preterm monochorionic twins with twin-to-twin transfusion syndrome after intrauterine treatment with amnioreduction or fetoscopic laser surgery:: comparison with dichorionic twins

OBJECTIVE: The purpose of this study was to compare neonatal outcome in preterm neonates after twin-to-twin transfusion syndrome ( TTTS) that was treated by amnioreduction or fetoscopic laser surgery (FLS) and in dichorionic neonates who were matched for gestational age at birth. STUDY DESIGN: Neonatal outcome was assessed in 137 TTTS preterm neonates who were treated primarily with either amnioreduction ( n = 36) or FLS ( n = 101) and compared with dichorionic twins ( n = 242) who were delivered at our center at 24-34 weeks of gestation. RESULTS: Adverse neonatal outcome ( death or severe cerebral lesions) was more frequent in the amnioreduction group than in the FLS and dichorionic groups. Overall neonatal outcome was comparable in FLS and dichorionic infants. However, neonatal morbidity was higher in FLS neonates at < 30 weeks of gestation that was related mainly to failed laser therapy. CONCLUSION: In preterm TTTS cases, neonatal morbidity decreases independently with gestational age and after successful FLS. Neonatal morbidity that was specific of TTTS was higher in the amnioreduction group and in cases with failed laser therapy.