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Poster Session 1

(144) Influence of the Solomon technique in TTTS on survival and abruption – temporal or causal?

Thursday, January 30, 2025
10:30 AM – 12:30 PM  

    Submitting Author and Presenting Author(s)

  • Bettina Paek, MBA, MD

    Co-Director, Maternal Fetal Intervention and Surgery Program
    Seattle Children's Hospital
    Seattle, Washington, United States

    • Coauthor(s)

  • MD

    Melissa Dorn, BSc

    Seattle Children's Hospital
    Seattle, Washington, United States

  • MW

    Martin Walker, MD

    Attending Physician
    Seattle Children's Hospital
    Seattle, Washington, United States

Objective:

The fetoscopic laser Solomon technique (FLS) for treatment of Twin-Twin Transfusion Syndrome (TTTS) has been associated with an increased risk of placental abruption while also improving neonatal survival when compared to standard fetoscopic laser (FL). We aimed to determine the impact of implementation of FLS on neonatal survival and placental abruption.

Study Design: We conducted a single center retrospective study of patients with mo-di twins undergoing Fl or FLS from 2003-2024. We used logistic regression, interrupted time series, and non-parametric analysis to determine the impact of adoption of FLS on neonatal survival and placental abruption.

Results:

 

Between 2003-2024, 584 mo-di twins underwent laser for the treatment of TTTS and had information on abruption status and neonatal outcomes available. FLS was adopted between 2013-2014. Patients undergoing FLS had improved chances of dual survival (84% vs 69%, p< 0.001) and an increased risk of abruption (15% vs 5%, p=0.027). There was no association between gestational age at surgery, placental position, number of anastomoses ablated or total fetoscopy time and risk of subsequent abruption.

However, survival showed a significant incremental improvement throughout the study period with dual survival (annual means) increasing from 63% to 88% for the last year that full data were available (p=0.02) and single survival decreasing from 38% to 9% (P=0.01). The frequency of no survivors ranged from 0-12% and did not change significantly over time. The rate of TAPS requiring treatment was low (< 2%) pre and post adoption of FLS.

Similarly, the rate of abruption increased starting early in the study period with a marginally significant decrease of the slope after adoption of FLS.  

 

Conclusion: While both survival and abruption increased during the study period, this increase predated the adoption of FLS. This raises the question of causal attribution to FLS versus other factors, such as operator experience or more extensive use of laser. A randomized trial may be required to assess the true impact of FLS on obstetric and neonatal outcomes.