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‘A problem shared is a problem halved’: success of a statewide collaborative approach to fetal therapy. Outcomes of fetoscopic laser photocoagulation for twin–twin transfusion syndrome in V ictoria

2013; Wiley; Volume: 53; Issue: 2 Linguagem: Inglês

10.1111/ajo.12062

1479-828X

Mark Teoh, Susan P. Walker, Stephen Cole, Andrew Edwards,

Prenatal Screening and Diagnostics

Aims To evaluate the performance of a collaborative fetal therapy service for treatment for twin–twin transfusion syndrome ( TTTS ). Methods The V ictorian F etal T herapy S ervice ( VFTS ) was developed in 2006. It is a state‐based three‐centre collaborative service comprising a surgical team and clinical leadership group, designed to optimise access to, and performance of, fetoscopic procedures in V ictoria. This is a prospective cohort study of VFTS patients referred for fetoscopic laser photocoagulation ( FLP ) for TTTS since 2006. Results Forty‐nine consecutive women with advanced (stage 2–4) TTTS between 2006 and 2011 were included in this study. Overall survival was 67 of 98 (68%), and survival of ≥1 twin was seen in 42 of 49 pregnancies (86%). There was no difference in survival by disease stage at diagnosis (≥1 survivor: 66% (stage 2 or 3 TTTS ) vs 77% (stage 4 TTTS ), P = 0.44), nor by surgical era (≥1 survivor: 60% (2006–2008) vs 74% of cases (2009–2011), P = 0.21). The median gestation gained post‐ FLP was 10.5 weeks. Conclusion These results are consistent with published series and confirm the success of a novel service delivery model for fetal therapy in V ictoria. We suggest that collaborative models such as ours should be considered for fetal conditions where treatment is complex and the total number of cases is small to ensure a consistent approach to assessment, management and follow‐up of patients and to optimise training and research opportunities.