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Maternal Fetal Medicine reports world-class results

In March 2009, the results of the first 100 laser ablations for severe twin-to-twin transfusion syndrome (TTTS) at Mater Mothers’ Hospitals were published in the Australian and New Zealand Journal of Obstetrics and Gynaecology.

The results and survival outcomes for this condition were found to be the best published for a series of this size in the world—highlighting Mater’s position at the cutting edge of maternal fetal medicine.

The study’s aim was to report the perinatal outcomes of a significant series of twin pregnancies with severe TTTS that were managed through Mater Mothers’ Hospitals Centre for Maternal Fetal Medicine and to compare these outcomes with other large facilities.

One hundred consecutive pregnancies from Australia, New Zealand and South East Asia managed with selective fetoscopic laser ablation from March 2002 to June 2007 were examined, survival and neonatal morbidity were analysed and compared against the results of other studies of the same size or larger.

According to the study, TTTS occurs in up to 15 per cent of monochorionic pregnancies and if untreated can result in the loss of one or both twins.

In recent times amnioreduction has been the standard treatment for TTTS pregnancies, with survival rates of 50 to 70 per cent most commonly reported.

Of the 100 women treated with laser ablation in this study 34 were stage II, 44 stage III, and 22 at stage IV. The median gestation at the time of laser ablation was 21 weeks and median gestation at delivery was 31 weeks.

In 85 per cent of these pregnancies, laser treatment resulted in the survival of at least one child, with the overall perinatal survival rate of 75.5 per cent.

Of particular note is the survival rate of stage IV TTTS at 88.6 per cent, which is significantly better than stage II and stage III pregnancies at 69.1 per cent and 73.9 per cent respectively. Under previous treatments, stage IV cases typically experienced the worst outcomes.

These results were found to be comparable to the best reported international series for the management of severe TTTS.

Long term follow up of the survivors of TTTS pregnancies treated with laser surgery is important and will be reported at a later stage.

Mater’s Centre for Maternal Fetal Medicine consists of a multidisciplinary team including medical, nursing and midwifery staff, neonatologists, anaesthetists, paediatric surgeons, theatre staff and sonographers.

The article is the published work of Dr Robert Cincotta, Dr Peter Gray, Dr Glenn Gardener, Barbara Soong and Dr Fung Yee Chan.

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