Laser therapy and serial amnioreduction as treatment for twin-twin transfusion syndrome: a metaanalysis and review of literature

OBJECTIVE: The objective of the study was to review current controversy on laser therapy ( LT) vs serial amnioreduction ( SA) performed for twin-twin transfusion syndrome (TTTS). STUDY DESIGN: A search in PubMed from 1997-2007 was performed. Inclusion criteria were diamniotic monochorionic pregnancy, TTTS diagnosed with standard parameters, and peri- and neonatal outcomes well defined. Triplets and investigations on other topics of TTTS rather than perinatal outcomes were excluded. A metaanalysis was performed by fixed-effect model (heterogeneity < 25%). RESULTS: Ten articles provided 611 cases of TTTS ( LT: 70%; SA: 30%) and included 4 studies comparing the 2 treatments ( 395 cases: LT, 58%; SA, 42%). Fetuses undergoing LT were more likely to survive than fetuses undergoing SA ( overall survival rate: P < .0001; odds ratio [OR], 2.04; 95% confidence interval [CI], 1.52-2.76; neonatal death: P < .0001; OR, 0.24; 95% CI, 0.15-0.40; neurologic morbidity: P < .0001; OR, 0.20; 95% CI, 0.12-0.33). CONCLUSION: This metaanalysis shows that LT is associated with better outcomes than SA and proposes new topics for future research.