{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:57:06Z","timestamp":1786978626706,"version":"build-2736575974"},"reference-count":37,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The aim of this study was to evaluate the perinatal outcomes of monochorionic diamniotic (MCDA) twin pregnancies complicated by early twin\u2010to\u2010twin transfusion syndrome (TTTS) treated with fetoscopic laser surgery\u00a0(FLS), and to compare rates of fetal survival across Quintero stages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a multicenter retrospective cohort study of MCDA pregnancies complicated by TTTS diagnosed \u2264\u200918\u2009weeks' gestation (early TTTS) that underwent FLS from January 2007 to August 2023. Monoamniotic twins, triplets or higher\u2010order multiple gestations, and pregnancies complicated by genetic or structural anomalies were excluded. Demographic data, gestational age at diagnosis and at FLS, Quintero stage at diagnosis and details of management of the pregnancy, including complications and perinatal outcomes, were obtained from patient records at each participating center. The primary outcome was survival at 28\u2009days after birth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 678 MCDA pregnancies with early TTTS were identified, of which 550 underwent FLS. Of these, 485 cases had a known pregnancy outcome and were therefore included. The median gestational age at diagnosis was 17\u2009+\u20090 (interquartile range (IQR), 16\u2009+\u20093 to 17\u2009+\u20094)\u2009weeks, and median gestational age at FLS was 17\u2009+\u20094 (IQR, 17\u2009+\u20090 to 17\u2009+\u20096)\u2009weeks. The most common Quintero stage at diagnosis was Stage\u2009III (46.0% (223\/485)). At least one postoperative complication occurred in 36.5% (177\/485) of cases, including preterm prelabor rupture of membranes, intrauterine fetal demise of the cotwin, vaginal bleeding, septostomy and pregnancy loss. Dual\u2010twin survival was reported in 51.5% (250\/485) of cases, while survival of at least one twin was reported in 76.7% (372\/485). There were no surviving fetuses in 23.3% (113\/485) of pregnancies. When considering cases diagnosed \u2264\u200916\u2009weeks, the rate of survival of at least one twin was 87.5% for cases diagnosed at Quintero Stages\u2009I\u2013II\n                      <jats:italic>vs<\/jats:italic>\n                      59.5% for Stages\u2009III\u2013IV (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.019).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      The diagnosis and management of TTTS \u2264\u200918\u2009weeks are more complex than those of TTTS diagnosed &gt;\u200918\u2009weeks. More early\u2010TTTS cases were diagnosed at Quintero Stage\u2009III, but the overall survival rate was not significantly different between cases diagnosed at Quintero Stages\u2009I\u2013II\n                      <jats:italic>vs<\/jats:italic>\n                      Stages\u2009III\u2013IV, except when the diagnosis was made \u2264\u200916\u2009weeks, in which case the survival rate was higher among cases diagnosed at\u00a0Stages\u2009I\u2013II. Revisions to the diagnostic criteria for early TTTS should be considered. \u00a9 2026 The Author(s).\n                      <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic>\n                      published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.70196","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T09:31:37Z","timestamp":1774863097000},"page":"461-469","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Perinatal outcomes of twin pregnancies complicated by early twin\u2010to\u2010twin transfusion syndrome treated with fetoscopic laser surgery"],"prefix":"10.1002","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7380-0576","authenticated-orcid":false,"given":"F. G.","family":"Sileo","sequence":"first","affiliation":[{"name":"Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust University of London  London UK"},{"name":"Prenatal Medicine Unit University of Modena and Reggio Emilia  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2802-7670","authenticated-orcid":false,"given":"A.","family":"Khalil","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust University of London  London UK"},{"name":"Vascular Biology Research Centre Molecular and Clinical Sciences Research Institute, St George's University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Binder","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Feto\u2010Maternal Medicine Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Brunelli","sequence":"additional","affiliation":[{"name":"Obstetric Unit, Department of Medical and Surgical Sciences University of Bologna and IRCCS Azienda Ospedaliero\u2010Universitaria S.Orsola\u2010Malpighi  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Chianchiano","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Bucchieri La Ferla\u2010Fatebenefratelli Hospital  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. M.","family":"Coutinho","sequence":"additional","affiliation":[{"name":"Hospital das Cl\u00ednicas da Faculdade de Medicina de Ribeir\u00e3o Preto da Universidade de S\u00e3o Paulo  Ribeir\u00e3o Preto Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"D'Antonio","sequence":"additional","affiliation":[{"name":"Center for Fetal Care and High\u2010Risk Pregnancy, Department of Obstetrics and Gynecology University \u201cG. d'Annunzio\u201d of Chieti\u2010Pescara  Chieti Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"D\u00f6bert","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Fetal Medicine University Medical Center Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Fichera","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Sciences University of Brescia  Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y.","family":"Gielchinsky","sequence":"additional","affiliation":[{"name":"Fetal Medicine Center, Helen Schneider Hospital for Women, Rabin Medical Center  Petach Tikvah Israel"},{"name":"Faculty of Medical and Health Sciences Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Hecher","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Fetal Medicine University Medical Center Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Iacovella","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Dr. Senckenbergische Stiftung, Buergerhospital  Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Malone","sequence":"additional","affiliation":[{"name":"Department of Maternal\u2010Fetal Medicine Royal Women's Hospital  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Martinez\u2010Varea","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology La Fe University and Polytechnic Hospital  Valencia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. 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