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CME Credit Offered
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Poster Session 1

(314) Fetoscopic Laser Outcomes by Placenta Location

Thursday, January 30, 2025
10:30 AM – 12:30 PM  
Objective: Among complicated monochorionic twin gestations requiring fetoscopic intervention, it is unclear whether placenta locations affect surgical outcomes and is important in patient counseling. Thus, we aim to compare procedural and pregnancy outcomes from selective fetoscopic laser procedures for complicated monochorionic twin pregnancies by placenta location. 

Study Design: We conducted a retrospective analysis of all fetoscopic laser procedures completed in monochorionic twin pregnancies at a single, large fetal center from November 2017 to May 2024. Outcomes were compared by placenta location based on preoperative ultrasound: anterior and posterior. Operative, obstetric, and neonatal outcomes were abstracted from the electronic medical record. Subgroup analysis was completed for twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS). Bivariate analyses were completed.

Results: Of the 126 fetoscopic laser procedure cases completed, 40.5% had anterior placenta and 59.5% had posterior placenta. The most common indication was selective fetoscopic laser photocoagulation (SFLP) for management of TTTS (108), followed by laser dichorionization for sFGR (18) and diagnostic fetoscopy (8). The total operative time was longer in cases with anterior placenta (75 vs. 68 minutes, respectively, p</span> = 0.04), however laser time was similar (3.42 vs. 2.83 minutes, respectively, p = 0.61). There was no difference in rates of perioperative complications or preterm prelabor rupture of membranes (Table 2). There was no difference in donor or recipient demise or neonatal survival for cases completed for either TTTS by placenta location (Table 2). 

Conclusion: Anterior placenta location is associated with increased operative duration for fetoscopic procedures, yet obstetric and neonatal outcomes are similar for procedures completed for both TTTS and sFGR regardless of placenta location.