Fetoscopia y coagulación láser en transfusión fetofetal: resultados y evolución neonatal

Gratacós, E.; Carreras, E.; Becker, J.; Ruiz, C.; Higueras, T.; Llurba, E.; Delgado, J.; Perapoch, J.; Cabero, L.L.

doi:10.1016/S0304-5013(03)75908-1

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Bibliografía

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Resumen

Objetivo

Evaluar los resultados perinatales en los primeros 50 casos de transfusión feto-fetal (TFF) tratados en España con coagulación fetoscópica láser de anastomosis placentarias

Sujetos y métodos

Estudio prospectivo con 50 casos de TFF grave tratadas con láser. Se evaluó la supervivencia y la evolución neonatales, las complicaciones obstétricas, y la tasa de lesión neurológica neonatal (28 días)

Resultados

La edad gestacional media de tratamiento fue de 19,8 semanas (rango: 16,6–25,8). La supervivencia neonatal global fue del 72% (72/100), con un 86% (43/50) de casos con, al menos, un superviviente. Ocurrió rotura prematura de membranas en 9 pacientes (18%), tres de ellas (6%) precoces (menos de 32 semanas). La edad gestacional media de parto fue de 31,8 semanas (rango: 26,0-38,2), con un 94% (47/50) por encima de las 28 semanas. El peso medio fue de 1.840 g (rango: 640-3.390) para receptores y 1.415 g (rango: 390-2.250) en donantes. Se observó algún grado de lesión neurológica en el 5,5% (4/72) de los supervivientes

Conclusión

Los resultados presentados se sitúan en el rango alto de lo previamente reportado por otros grupos. La coagulación fetoscópica láser permite ofrecer una alternativa terapéutica a una proporción importante de casos de TFF grave

Palabras clave:

Gestación gemelar monocorial

Transfusión fetofetal

Fetoscopia

Summary

Objective

To evaluate perinatal outcome in the first 50 cases of severe twin-twin transfusion syndrome (TTS) treated in Spain with fetoscopic laser coagulation of the placental anastomoses

Patients and methods

We performed a prospective study of 50 cases of severe TTS treated with laser therapy. The main outcome measures were perinatal outcome, obstetric complications and the rate of neurological damage at 28 days

Results

The mean gestational age at therapy was 19.8 weeks (range: 16.6–25.8). Overall neonatal survival was 72% (72/100) and at least one twin survived in 86% (43/50) of the pregnancies. Premature rupture of membranes occurred in nine patients (18%). In three of these patients (6%), rupture developed before 32 weeks. The mean gestational age at delivery was 31.8 weeks (26.0- 38.2), and 94% (47/50) of the women delivered after 28 weeks. The mean birthweight was 1840 grams (range: 640-3390) in recipients and 1415 grams (range 390-2250) in donors. Some degree of neurological damage was observed in 5.5% (4/72) of survivors

Conclusions

The results of this series are in the upper range of previously reported results. Fetoscopic laser coagulation is an effective treatment in a considerable proportion of pregnancies complicated with severe TTS

keywords:

Monochorionic twin pregnancy

Twin-twin transfusion syndrome

Fetoscopy

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