(99) Stage based survival after fetoscopic laser ablation treatment of twin-transfusion syndrome using the ‘Solomon technique’

FBetween 2014-22, 373 TTTS patients had Solomon FLS; 19.9%  were Stage I, 30.6% were Stage II, 43.5% were Stage III, and 5.6% were stage IV (table). Co-existing selective fetal growth restriction was most common in stage III (p < 0.001) (Table). Solomon technique was successful in 347 (97.7%). In addition to Solomon, we also performed sequential anastomosis ablation in 51 patients with significant growth discordance (14.4%).  Double survival by 48 hours after laser did not differ between TTTS stages (p=0.292). Double survival at birth occurred in 76.1% (270) patients, single survival in 16.9% (60) and 7% (25) had no survivors. Dual birth survival was statistically similar between  stages, though numerically lower in Stage III (p=0.103).


Conclusion: Solomon laser achieves resolution of TTTS in a high proportion of cases allowing for disease recovery and double survival. Unequal placental sharing responsible for fetal size discordance appears to be the primary obstacle to achieve double survival.