Laser therapy for severe TTTS: Comparison between triplets and twins

Introduction: Laser coagulation of placental anastomoses in twin-pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) has been shown to be superior to serial amniodrainages and emerged as the standard therapy for this condition. This study compares the outcome of triplet pregnancies with twin pregnancies, both treated with laser therapy for severe TTTS in the same center. Methods: Data from all pregnancies were entered prospectively into a computer database. For the purpose of this study the database was searched for all triplet pregnancies that were complicated by severe TTTS. Perinatal outcome and follow-up was obtained in all but one still ongoing cases. Results: There were 18 cases of triplet pregnancies with severe TTTS. 16 were treated with laser therapy, 1 with amniodrainage and one miscarried before any treatment was possible. 14 of them were dichorionic, 4 monochorionic, all cases were triamniotic. Laser therapy was performed at a median gestational age of 19.6 weeks (range 18–22). The median amniotic fluid drained after the laser procedure was 2200ml. Delivery took place at a median of 32 weeks (range 25–36). In 10 cases (66%) there were at least 2 survivors after laser therapy and in 6 cases (40%) all 3 fetuses survived. The overall survival rate after laser therapy was 62%. Corresponding data for twin pregnancies treated with laser therapy at our center were as follows: at least one survivor in 87%, two in 64% and overall survival rate was 76%. Conclusion: To our knowledge this study comprises the largest number of triplets treated with laser therapy for TTTS. It is an effective therapeutic option for severe TTTS in both, triplet and twin pregnancies.