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© 2009 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 28:633-639 • 0278-4297

Are Patients With Twin-Twin Transfusion Syndrome and a Very Short Cervix Candidates for Laser Surgery?

Emiliano R. Chavira, MD, MPH, Amer Khan, MBBS, Lisa M. Korst, MD, PhD, David Miller, MD, Thomas M. Goodwin, MD and Ramen H. Chmait, MD

Division of Maternal-Fetal Medicine, University of Southern California Keck School of Medicine, Los Angeles, California USA (E.R.C., L.M.K., D.M., T.M.G., R.H.C.); and Institute for Maternal-Fetal Health, Children’s Hospital Los Angeles/University of Southern California Keck School of Medicine, Los Angeles, California USA (A.K., D.M., R.H.C.).

Address correspondence to Ramen H. Chmait, MD, Division of Maternal-Fetal Medicine, University of Southern California Keck School of Medicine, 1300 N Vermont Ave, Suite 706, Los Angeles, CA 90027 USA., E-mail: chmait{at}usc.edu

Objectives. The purpose of this study was to determine the relationship between cervical length (CL) and perinatal outcomes in cases of twin-twin transfusion syndrome (TTTS) treated with laser surgery and to assess whether patients with a very short cervix (0.5–1.9 cm) are appropriate candidates for laser surgery. Methods. All women who underwent laser surgery for TTTS from March 2006 to April 2008 at the study institution were evaluated consecutively. Patients were grouped according to pre-operative CL: greater than 2.5, 2 to 2.5, and 0.5 to 1.9 cm. The gestational age at delivery, latency from laser surgery to delivery, and 30-day neonatal survival were documented prospectively and compared among these groups. Results. The 99 women in the study population were grouped by CL: greater than 2.5 cm (n = 76), 2 to 2.5 cm (n = 13), and 0.5 to 1.9 cm (n = 10). For these groups, the median gestational ages at delivery were 34, 32.29, and 31.86 weeks, respectively (P = .411). The median latencies from laser surgery to delivery were 12.79, 11, and 11.07 weeks (P = .424). The frequency rates of at least 1 surviving twin were 69 of 76 (91%), 13 of 13 (100%), and 8 of 10 (80%) (P = .254). Finally, dual survivors were observed in 54 of 76 (71%), 12 of 13 (92%), and 5 of 10 (50%) (P = .08). Conclusions. In cases of TTTS complicated by a very short cervix (0.5–1.9 cm), treatment with laser surgery resulted in perinatal outcomes that were sufficiently favorable to justify the surgery, suggesting that these patients should not be excluded from undergoing laser surgery for TTTS.

Key Words: cervical length • laser photocoagulation of communicating vessels • perinatal outcomes • short cervix • twin-twin transfusion syndrome

Abbreviations: CL, cervical length • TTTS, twin-twin transfusion syndrome

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Copyright © 2009 by the American Institute of Ultrasound in Medicine.