Risk factors and outcomes following septostomy during fetoscopic surgery for twin-to-twin transfusion syndrome

Clifton O. Brock, Eric P. Bergh, Ramesha Papanna, Edgar A. Hernandez-Andrade, Rodrigo Ruano, Anthony Johnson

Research output: Contribution to journalArticlepeer-review


Fetoscopic laser photocoagulation (FLP) of placental anastomoses is the preferred treatment for twin-to-twin transfusion syndrome (TTTS). Iatrogenic septostomy (IOS) during FLP is associated with increased risk of neonatal morbidity and mortality. We sought to identify risk factors for IOS and quantify the resultant outcomes. This is a secondary analysis of prospectively collected cases of TTTS in monochorionic diamniotic twins following FLP at a single center. Pre-operative ultrasound characteristics and operative technique (i.e., cannula size, total energy used) were compared between cases with vs. without IOS. Pregnancy and neonatal outcomes were also compared. Of 475 patients that had FLP, 33 (7%) were complicated by IOS. There was no association between operative technique and IOS. IOS was more common with later diagnosis, but less likely when selective fetal growth restriction (sFGR) was present. Survival was similar between groups (76% vs. 76% dual survivors, p = 0.95); however, IOS was associated with earlier delivery (29.7 vs. 32.0 wks, p < 0.01) and greater composite neonatal morbidity (25% vs. 8% in both twins, p = 0.02). Risks of IOS at greater gestational ages without sFGR may be related to a larger collapsed intervening membrane area and the resulting increased risk of puncture on entry.

Original languageEnglish (US)
Article number3693
JournalJournal of Clinical Medicine
Issue number16
StatePublished - Aug 2021


  • Fetal medicine
  • Fetal surgery
  • Monochorionic diamniotic twins
  • Placental laser surgery
  • Prenatal ultrasound
  • Septostomy
  • Twin-to-twin transfusion syndrome

ASJC Scopus subject areas

  • Medicine(all)


Dive into the research topics of 'Risk factors and outcomes following septostomy during fetoscopic surgery for twin-to-twin transfusion syndrome'. Together they form a unique fingerprint.

Cite this