(338) Application of the Solomon Laser Technique to Dichorionic-Triamniotic Triplet Gestations with Twin-to-Twin Transfusion Syndrome

The Solomon technique for laser surgery in monochorionic (MC) twins with twin to twin transfusion syndrome (TTTS) may be associated with higher survival but also an increased risk for placental abruption. Dichorionic triamniotic (DCTA) triplets with TTTS are candidates for Solomon laser surgery, however, Solomon outcomes have not been directly studied for triplet gestations. We evaluated the outcomes of Solomon laser in DCTA triplets compared to MCDA twins.


Study Design:

Triplets were matched 4:1 with twins for TTTS Stage III, co-existing selective fetal growth restriction (sFGR), cervical length (CL) (< 20 or ≥20 mm), and gestational age (GA) at laser (< 18, 18-24, >24 weeks). Patients were compared for maternal demographics, pretreatment characteristics, procedural details, and post-treatment outcomes. Our primary outcome was gestational age (GA) at birth. Continuous data were analyzed using student’s t or Wilcoxon Rank-Sum test. Categorical data were analyzed using Pearson’s chi squared or Fisher’s Exact test. 


Results:

Ten triplets were matched to 40 twins after Solomon laser.  The median GA at delivery was lower in triplets (30.6 vs 33.3 weeks, p=0.04) and the interval from laser to delivery was shorter (9.1 vs 12.3 weeks, p=0.04). There was no difference in laser energy, fetoscopy time, PPROM, fetal demise within 48 hours of laser, septostomy, birth survival, or abruption (see table).


Conclusion:

When matched for known TTTS risk modifiers such as stage, sFGR, CL and GA at laser, DCTA triplets undergoing Solomon laser for TTTS deliver about 3 weeks earlier than MCDA twins due to a shorter laser to delivery interval. However, intraoperative parameters and survival are similar and overall favorable for both groups after Solomon laser.