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The Fetal Center at Children's Memorial Hermann Hospital Reaches Milestone for Laser Ablation

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The Fetal Center reached a significant milestone in May, when physicians affiliated with the Center performed the 100th laser ablation to treat twin-to-twin transfusion syndrome (TTTS) since the Center opened in 2011.

TTTS IllustrationThe Fetal Center reached a significant milestone in May, when physicians affiliated with the Center performed the 100th laser ablation to treat twin-to-twin transfusion syndrome (TTTS) since the Center opened in 2011.

Dr. Moise added that while many of their patients come from Texas, physicians affiliated with The Fetal Center often treat patients from surrounding states, having performed the ablation on patients from as far as North Dakota and Alaska. “We have four highly experienced surgeons on staff performing laser ablation to treat TTTS,” said Dr. Moise. “We are diligent about structuring our time off to ensure that there are always two of us here at any time. We always ‘leave the light on’ at the Center for the patients.”

One in five twin pregnancies results in identical twins, which carry a much higher risk of complications. One such complication is TTTS, which occurs when twins share one placenta with connecting vessels that allow unequal exchange of blood between the fetuses. The condition effects up to 15 percent of identical twins, and if left untreated, results in high mortality and morbidity for both fetuses.

Laser ablation of the communicating vessels between the two fetuses is the recommended therapy for Stage II TTTS and more advanced stages, and can be performed between 16 and 26 weeks gestation. Survival of at least one twin is seen in approximately 90 percent of cases, with survival of both fetuses in 70 to 75 percent of cases. The average gestational age at delivery is 31 weeks.

“In the past, serial amnioreduction was the recommended treatment,” said Dr. Moise. “It made the mother much more comfortable, but it didn’t fix the problem. Ultimately, the overall survival rate for babies with this technique is much lower than laser treatment.” At press time, Dr. Moise and his colleagues at the Texas Fetal Center have performed more than 135 laser ablations to treat TTTS, with a 76 percent survival rate for both fetuses. Team members have performed more than 800 TTTS laser ablations combined throughout their careers.

“The recommendation is that once monochorionic twins have been identified, usually around 16 weeks gestation, an ultrasound should be performed every two weeks,” said Dr. Moise. “However, recent research has shown that TTTS can present within a week of an ultrasound. Physicians need to be tuned in to the symptoms. We’ve come a long way in terms of quality outcomes for successfully treating these babies, but it all comes down to early detection.”

Meet the Team

Dr. Michael Bebbington 

Michael W. Bebbington, M.D., M.H.Sc.
Director, Prenatal Diagnosis and Fetal Imaging, The Fetal Center Professor, Department of Obstetrics, Gynecology and Reproductive Sciences and Department of Pediatric Surgery

   
Dr. Anthony Johnson Anthony Johnson, D.O.
Co-director, The Fetal Center
Professor, Department of Obstetrics, Gynecology and Reproductive Sciences and Department of Pediatric Surgery
   
Dr. Kenneth Moise Kenneth J. Moise, Jr., M.D.
Co-director, The Fetal Center
Professor, Department of Obstetrics, Gynecology and Reproductive Sciences and Department of Pediatric Surgery
   
Dr. Ramesha Papanna Ramesha Papanna, M.D., M.P.H.
Assistant Professor, Department of Obstetrics, Gynecology and Reproductive Sciences

Surveillance of Monochorionic Twins

Chorionicity is a critical consideration in the management of twin pregnancies. According to the Society for Maternal-Fetal Medicine, all women with a twin pregnancy should be offered an ultrasound exam at 10 to 13 weeks gestation to assess viability, chorionicity, crown-rump length and nuchal translucency.*

multiple gestation ultrasound algorithm

*SMFM, Simpson LL. Am J Obstet Gynecol 2013;208:3-18.