Prof. Dr. Ali EKİZ

Prof. Dr. Ali EKİZ

Gynecology and Perinatology (Risky Pregnancy) Specialist

With over 15 years of professional experience, dozens of national and international research articles, and most importantly, his smiling face, Gynecology and Perinatology Specialist Prof. Dr. Ali EKİZ is with you.

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Laser Ablation in TTTS

What is Laser Ablation in TTTS?

TTTS, abbreviated as Twin-Twin Transfusion Syndrome, is a disease specific to identical twins. Identical twin fetuses in the womb find vessels in the single placenta that allow blood exchange between the two fetuses. In these vascular connections, which are usually between twins, the blood taken and given is in a balance. In order for TTTS to develop, one fetus must get more blood than the other, and the other must live with less blood. As a result, one fetus becomes a “giver” while the other fetus becomes a “receiver.” In this article, we have compiled what you need to know about TTTS for you.

How is Twin to Twin Transfusion Syndrome diagnosed?

Identical twins are very special and very high-risk pregnancies because of the vascular connections described earlier. TTTS or some similar complications may develop in approximately 30% of identical twins.

For this reason, monochorionic twins should be followed by a Perinatology specialist.

Symptoms of TTTS on ultrasound; It can be listed as more than 20% difference between the estimated weights of the fetuses, excess water (polyhydramnios) in one of the fetuses, low water (oligohydramnios) in the other fetuses, and detection of blood flow (doppler) disorders.

The perinatologist plans the intervention time by looking at the ultrasound symptoms.

How Is TTTS Treated?

The most effective treatment of TTTS is laser ablation surgery. Laser ablation is known as a surgical procedure used to close abnormally functioning vascular connections between twin fetuses. The procedure can be performed under general anesthesia or local anesthesia. However, it is ideal to be done under general anesthesia.

In the laser ablation procedure, a small entrance gate is created with a 3 mm trocar half in the mother’s abdomen. From here, a camera system called a fetoscope is inserted to see inside the uterus. A thin transparent laser fiber is inserted through the memory entrance door.

Then, the veins that cause the disease between the two fetuses are burned. In this way, the two fetuses are completely separated from each other vascularly.

When Is Laser Ablation Done?

The laser ablation procedure is usually performed during the second trimester of pregnancy, that is, between 16 and 26 weeks of pregnancy. The procedure is performed by a perinatologist. After the procedure, the condition of the fetuses is regularly monitored and followed as the pregnancy progresses.

Laser ablation is an effective method of treating TTTS and greatly increases the twins’ chances of survival. Nevertheless, the treatment plan and success rate should be evaluated individually in each case and should be followed up with the progression of the pregnancy.

What Are the Risks of Laser Ablation Treatment for TTTS?

Laser ablation therapy for TTTS can carry several risks. We can list these risks as follows:

• Risk of preterm birth: Because the laser ablation procedure is performed inside the uterus, the risk of preterm birth may increase. Intrauterine processes can cause the uterus to contract and trigger labor. Therefore, it is a procedure with a high risk of premature birth.

• Since the trocar used during the procedure pierces the amniotic membrane around the fetus, it may cause membrane rupture and cause the flow of water. This complication may increase up to about 30%.

• Post-procedural complications: Complications such as infection, bleeding or fluid accumulation in the mother’s womb may occur after laser ablation. Such complications can affect both the mother and fetus and may require treatment.

• Circulatory imbalance between twins: Laser ablation is performed to correct the circulatory imbalance caused by TTTS. However, even after the procedure, sometimes the circulatory imbalance between the twins may continue or a new imbalance may occur. This condition is known as post-laser anemia. Anemia may develop in one of the fetuses after the procedure.

• After the 26th week, laser ablation surgery is not usually performed, but it is still evaluated according to these examination findings.

All pregnant women should not neglect to have a perinatology examination twice during their pregnancy, one between 11-14 weeks and the other between 20-24 weeks.

You can contact Prof Dr Ali Ekiz for all treatments in the womb.

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