Fetoscopic laser ablation of placental anastomoses in twin-twin transfusion syndrome using 'Solomon technique'

Rodrigo Ruano, C. Rodo, J. L. Peiro, A. A. Shamshirsaz, S. Haeri, M. L. Nomura, E. M.A. Salustiano, K. K. De Andrade, H. Sangi-Haghpeykar, E. Carreras, M. A. Belfort

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Objective: To document perinatal outcomes following use of the 'Solomon technique' in the selective photocoagulation of placental anastomoses for severe twin-twin transfusion syndrome (TTTS). Methods: Between January 2010 and July 2012, data were collected from 102 consecutive monochorionic twin pregnancies complicated by severe TTTS that underwent fetoscopic laser ablation at four different centers. We compared outcomes between subjects that underwent selective laser coagulation using the Solomon technique (cases) and those that underwent selective laser coagulation without this procedure (controls). Results: Of the 102 pregnancies examined, 26 (25.5%) underwent the Solomon technique and 76 (74.5%) did not. Of the 204 fetuses, 139 (68.1%) survived up to 30 days of age. At least one twin survived in 82 (80.4%) pregnancies and both twins survived in 57 (55.9%) pregnancies. When compared with the control group, the Solomon-technique group had a significantly higher survival rate for both twins (84.6 vs 46.1%; P < 0.01) and a higher overall neonatal survival rate (45/52 (86.5%) vs 94/152 (61.8%); P < 0.01). Use of the Solomon technique remained independently associated with dual twin survival (adjusted odds ratio (aOR), 11.35 (95% CI, 3.11-53.14); P = 0.0007) and overall neonatal survival rate (aOR, 4.65 (95% CI, 1.59-13.62); P = 0.005) on multivariable analysis. There were no cases of recurrent TTTS or twin anemia-polycythemia sequence (TAPS) in the Solomon-technique group. Conclusions: Use of the Solomon technique following selective laser coagulation of placental anastomoses appears to improve twin survival and may reduce the risk of recurrent TTTS and TAPS. Our data support the idea of performing a randomized controlled trial to evaluate the effectiveness of the Solomon technique.

Original languageEnglish (US)
Pages (from-to)434-439
Number of pages6
JournalUltrasound in Obstetrics and Gynecology
Volume42
Issue number4
DOIs
StatePublished - Oct 1 2013
Externally publishedYes

Fingerprint

Fetofetal Transfusion
Laser Therapy
Laser Coagulation
Polycythemia
Twin Pregnancy
Anemia
Odds Ratio
Pregnancy
Light Coagulation
Fetus
Randomized Controlled Trials
Control Groups

Keywords

  • Fetal surgery
  • fetoscopy
  • laser ablation
  • monochorionic twin pregnancy
  • twin anemia-polycythemia sequence
  • twin oligopolyhydramnios sequence
  • twin-twin transfusion syndrome

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Reproductive Medicine
  • Radiology Nuclear Medicine and imaging
  • Obstetrics and Gynecology

Cite this

Fetoscopic laser ablation of placental anastomoses in twin-twin transfusion syndrome using 'Solomon technique'. / Ruano, Rodrigo; Rodo, C.; Peiro, J. L.; Shamshirsaz, A. A.; Haeri, S.; Nomura, M. L.; Salustiano, E. M.A.; De Andrade, K. K.; Sangi-Haghpeykar, H.; Carreras, E.; Belfort, M. A.

In: Ultrasound in Obstetrics and Gynecology, Vol. 42, No. 4, 01.10.2013, p. 434-439.

Research output: Contribution to journalArticle

Ruano, R, Rodo, C, Peiro, JL, Shamshirsaz, AA, Haeri, S, Nomura, ML, Salustiano, EMA, De Andrade, KK, Sangi-Haghpeykar, H, Carreras, E & Belfort, MA 2013, 'Fetoscopic laser ablation of placental anastomoses in twin-twin transfusion syndrome using 'Solomon technique'', Ultrasound in Obstetrics and Gynecology, vol. 42, no. 4, pp. 434-439. https://doi.org/10.1002/uog.12492
Ruano, Rodrigo ; Rodo, C. ; Peiro, J. L. ; Shamshirsaz, A. A. ; Haeri, S. ; Nomura, M. L. ; Salustiano, E. M.A. ; De Andrade, K. K. ; Sangi-Haghpeykar, H. ; Carreras, E. ; Belfort, M. A. / Fetoscopic laser ablation of placental anastomoses in twin-twin transfusion syndrome using 'Solomon technique'. In: Ultrasound in Obstetrics and Gynecology. 2013 ; Vol. 42, No. 4. pp. 434-439.
@article{d1623bc35a7045cf94cc0b10a2a779b8,
title = "Fetoscopic laser ablation of placental anastomoses in twin-twin transfusion syndrome using 'Solomon technique'",
abstract = "Objective: To document perinatal outcomes following use of the 'Solomon technique' in the selective photocoagulation of placental anastomoses for severe twin-twin transfusion syndrome (TTTS). Methods: Between January 2010 and July 2012, data were collected from 102 consecutive monochorionic twin pregnancies complicated by severe TTTS that underwent fetoscopic laser ablation at four different centers. We compared outcomes between subjects that underwent selective laser coagulation using the Solomon technique (cases) and those that underwent selective laser coagulation without this procedure (controls). Results: Of the 102 pregnancies examined, 26 (25.5{\%}) underwent the Solomon technique and 76 (74.5{\%}) did not. Of the 204 fetuses, 139 (68.1{\%}) survived up to 30 days of age. At least one twin survived in 82 (80.4{\%}) pregnancies and both twins survived in 57 (55.9{\%}) pregnancies. When compared with the control group, the Solomon-technique group had a significantly higher survival rate for both twins (84.6 vs 46.1{\%}; P < 0.01) and a higher overall neonatal survival rate (45/52 (86.5{\%}) vs 94/152 (61.8{\%}); P < 0.01). Use of the Solomon technique remained independently associated with dual twin survival (adjusted odds ratio (aOR), 11.35 (95{\%} CI, 3.11-53.14); P = 0.0007) and overall neonatal survival rate (aOR, 4.65 (95{\%} CI, 1.59-13.62); P = 0.005) on multivariable analysis. There were no cases of recurrent TTTS or twin anemia-polycythemia sequence (TAPS) in the Solomon-technique group. Conclusions: Use of the Solomon technique following selective laser coagulation of placental anastomoses appears to improve twin survival and may reduce the risk of recurrent TTTS and TAPS. Our data support the idea of performing a randomized controlled trial to evaluate the effectiveness of the Solomon technique.",
keywords = "Fetal surgery, fetoscopy, laser ablation, monochorionic twin pregnancy, twin anemia-polycythemia sequence, twin oligopolyhydramnios sequence, twin-twin transfusion syndrome",
author = "Rodrigo Ruano and C. Rodo and Peiro, {J. L.} and Shamshirsaz, {A. A.} and S. Haeri and Nomura, {M. L.} and Salustiano, {E. M.A.} and {De Andrade}, {K. K.} and H. Sangi-Haghpeykar and E. Carreras and Belfort, {M. A.}",
year = "2013",
month = "10",
day = "1",
doi = "10.1002/uog.12492",
language = "English (US)",
volume = "42",
pages = "434--439",
journal = "Ultrasound in Obstetrics and Gynecology",
issn = "0960-7692",
publisher = "John Wiley and Sons Ltd",
number = "4",

}

TY - JOUR

T1 - Fetoscopic laser ablation of placental anastomoses in twin-twin transfusion syndrome using 'Solomon technique'

AU - Ruano, Rodrigo

AU - Rodo, C.

AU - Peiro, J. L.

AU - Shamshirsaz, A. A.

AU - Haeri, S.

AU - Nomura, M. L.

AU - Salustiano, E. M.A.

AU - De Andrade, K. K.

AU - Sangi-Haghpeykar, H.

AU - Carreras, E.

AU - Belfort, M. A.

PY - 2013/10/1

Y1 - 2013/10/1

N2 - Objective: To document perinatal outcomes following use of the 'Solomon technique' in the selective photocoagulation of placental anastomoses for severe twin-twin transfusion syndrome (TTTS). Methods: Between January 2010 and July 2012, data were collected from 102 consecutive monochorionic twin pregnancies complicated by severe TTTS that underwent fetoscopic laser ablation at four different centers. We compared outcomes between subjects that underwent selective laser coagulation using the Solomon technique (cases) and those that underwent selective laser coagulation without this procedure (controls). Results: Of the 102 pregnancies examined, 26 (25.5%) underwent the Solomon technique and 76 (74.5%) did not. Of the 204 fetuses, 139 (68.1%) survived up to 30 days of age. At least one twin survived in 82 (80.4%) pregnancies and both twins survived in 57 (55.9%) pregnancies. When compared with the control group, the Solomon-technique group had a significantly higher survival rate for both twins (84.6 vs 46.1%; P < 0.01) and a higher overall neonatal survival rate (45/52 (86.5%) vs 94/152 (61.8%); P < 0.01). Use of the Solomon technique remained independently associated with dual twin survival (adjusted odds ratio (aOR), 11.35 (95% CI, 3.11-53.14); P = 0.0007) and overall neonatal survival rate (aOR, 4.65 (95% CI, 1.59-13.62); P = 0.005) on multivariable analysis. There were no cases of recurrent TTTS or twin anemia-polycythemia sequence (TAPS) in the Solomon-technique group. Conclusions: Use of the Solomon technique following selective laser coagulation of placental anastomoses appears to improve twin survival and may reduce the risk of recurrent TTTS and TAPS. Our data support the idea of performing a randomized controlled trial to evaluate the effectiveness of the Solomon technique.

AB - Objective: To document perinatal outcomes following use of the 'Solomon technique' in the selective photocoagulation of placental anastomoses for severe twin-twin transfusion syndrome (TTTS). Methods: Between January 2010 and July 2012, data were collected from 102 consecutive monochorionic twin pregnancies complicated by severe TTTS that underwent fetoscopic laser ablation at four different centers. We compared outcomes between subjects that underwent selective laser coagulation using the Solomon technique (cases) and those that underwent selective laser coagulation without this procedure (controls). Results: Of the 102 pregnancies examined, 26 (25.5%) underwent the Solomon technique and 76 (74.5%) did not. Of the 204 fetuses, 139 (68.1%) survived up to 30 days of age. At least one twin survived in 82 (80.4%) pregnancies and both twins survived in 57 (55.9%) pregnancies. When compared with the control group, the Solomon-technique group had a significantly higher survival rate for both twins (84.6 vs 46.1%; P < 0.01) and a higher overall neonatal survival rate (45/52 (86.5%) vs 94/152 (61.8%); P < 0.01). Use of the Solomon technique remained independently associated with dual twin survival (adjusted odds ratio (aOR), 11.35 (95% CI, 3.11-53.14); P = 0.0007) and overall neonatal survival rate (aOR, 4.65 (95% CI, 1.59-13.62); P = 0.005) on multivariable analysis. There were no cases of recurrent TTTS or twin anemia-polycythemia sequence (TAPS) in the Solomon-technique group. Conclusions: Use of the Solomon technique following selective laser coagulation of placental anastomoses appears to improve twin survival and may reduce the risk of recurrent TTTS and TAPS. Our data support the idea of performing a randomized controlled trial to evaluate the effectiveness of the Solomon technique.

KW - Fetal surgery

KW - fetoscopy

KW - laser ablation

KW - monochorionic twin pregnancy

KW - twin anemia-polycythemia sequence

KW - twin oligopolyhydramnios sequence

KW - twin-twin transfusion syndrome

UR - http://www.scopus.com/inward/record.url?scp=84884908155&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84884908155&partnerID=8YFLogxK

U2 - 10.1002/uog.12492

DO - 10.1002/uog.12492

M3 - Article

C2 - 23616360

AN - SCOPUS:84884908155

VL - 42

SP - 434

EP - 439

JO - Ultrasound in Obstetrics and Gynecology

JF - Ultrasound in Obstetrics and Gynecology

SN - 0960-7692

IS - 4

ER -