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TÜRKÇE
Poster - 45
Ultrasound-guided laser ablation in twin-twin transfusion syndrome: evaluating efficacy, safety, and perinatal outcomes
Muhammad Rafi Wibisana Sudradjat, Ryan Mario Christian
Faculty of Medicine Padjadjaran University, Bandung, Indonesia
Background: Twin-twin transfusion syndrome (TTTS) is a severe complication of monochorionic diamniotic twin pregnancies, resulting from unbalanced placental vascular anastomoses. Ultrasound-guided fetoscopic laser ablation, which coagulates these anastomoses, has become the standard treatment to improve survival and perinatal outcomes. This scoping review evaluates the efficacy, safety, and overall outcomes of the procedure.
Methods: A comprehensive literature search was performed across PubMed, Embase, Cochrane Library, and Web of Science for studies published up to June 2025. Keywords included “twin-twin transfusion syndrome,” “fetoscopic laser ablation,” “ultrasound-guided laser,” and “perinatal outcomes.” Eligible studies of any design that reported on efficacy, complications, and neonatal outcomes following the procedure were included. Due to variability in study design and outcome measures, data were synthesized descriptively.
Results: Included studies comprised randomized controlled trials, cohort studies, and large case series. Landmark investigations such as the Eurofetus trial and later meta-analyses showed that fetoscopic laser ablation improves survival of at least one twin to 70–80%, compared to ≤50% with conservative management. Procedural complications, including preterm premature rupture of membranes (PPROM) and preterm labor, occurred in 20–30% of cases. Perinatal outcomes indicated reduced neurological morbidity and increased gestational age at delivery. However, heterogeneity in outcome definitions and limited long-term neurodevelopmental data were common limitations.
Conclusion: Ultrasound-guided fetoscopic laser ablation is an effective and relatively safe intervention for TTTS, significantly improving survival and reducing perinatal morbidity compared to historical options. Risks such as preterm delivery persist, but the benefits remain substantial. There is a pressing need for standardized reporting of outcomes and extended neurodevelopmental follow-up. Future studies should refine surgical techniques and focus on long-term outcomes to improve overall TTTS care.