(931) Solomon technique of fetoscopic laser ablation is associated with improved perinatal outcomes

Friday, February 10, 2023

3:30 PM – 5:00 PM

Objective: Fetoscopic laser ablation of pathogenic vascular connections between twin circulations is the mainstay of treatment for twin-twin transfusion syndrome (TTTS). Laser photocoagulation can be performed in either a selective manner or by utilizing the Solomon technique. The purpose of this study was to assess differences in perinatal and neonatal outcomes between fetuses undergoing either selective laser ablation or laser photocoagulation using the Solomon technique for treatment of TTTS.

Study Design: This is a retrospective cohort study of fetoscopic laser ablation cases performed at a single center between 2011-2020. The primary outcome was the same composite used in the Solomon randomized controlled trial; it includes post-laser twin anemia-polycythemia sequence, TTTS recurrence, intrauterine fetal demise, and severe neurologic morbidity defined as intraventricular hemorrhage grade 3 or 4 or periventricular leukomalacia grade ≥2. Statistical analysis included chi-square test, t-test and Mann-Whitney U test. Logistic regression was performed to control for baseline differences between groups including gestational age (GA) at delivery and history of preterm delivery.

Results: Of the 76 fetoscopic laser ablations performed, 40 (53%) utilized a selective approach and 36 (47%) were performed by Solomon technique, corresponding to 80 and 72 fetal outcomes, respectively. History of preterm delivery varied between groups (11% in Solomon group vs. 0 in the selective group, p=.002) (Table 1). GA at delivery differed between groups with median GA 34.0 (IQR 5.5) weeks in the Solomon group vs. 29.6 (IQR 8.1) weeks in the selective group (p=.028) (Table 2). Both selective ablation (adjusted odds ratio (aOR) 4.1 [95% CI 1.1-15.8]) and GA at delivery (aOR 0.8 [95% CI 0.7-0.9]) were independently associated with the composite outcome.

Conclusion: Utilizing the Solomon technique during fetoscopic laser ablation for TTTS was associated with lower risk for composite adverse perinatal outcomes, possibly related to longer procedure-to-delivery interval and corresponding later gestational age at delivery.

Primary & Presenting Author(s)

Alexandra J.D Phelps, MD (she/her/hers)
Maternal-Fetal Medicine Fellow
Vanderbilt University Medical Center
Nashville, Tennessee, United States

Coauthor(s)

DL
Diamond Ling, MD
Adventist Shady Grove Medical Center
Rockville, Maryland, United States
TT
Tabitha Tate, MD
University of Minnesota Division of Neonatology
Minneapolis, Minnesota, United States
CH
Calla Holmgren, MD
Advocate Lutheran General Hospital
Park Ridge, Illinois, United States
PP
Preetha Prazad, MD
Advocate Children's Medical Group
Barrington, Illinois, United States
SM
Suwan Mehra, MD
Advocate Lutheran General Hospital
Park Ridge, Illinois, United States