VOLUME 17 (Supplement)

Early experience of fetal laser photocoagulation for twin-to-twin transfusion syndrome in the Philippines

Objectives: This study aims to review the outcomes of monochorionic pregnancies with Twin-to-Twin Transfusion Syndrome (TTTS) treated with fetal laser photocoagulation (FLP) in the Philippines and to compare these with outcomes from the early experiences of other nearby centers in Southeast and East Asia.

Methods: This is a single center retrospective cohort study of 7 patients who underwent FLP for TTTS before 26 weeks of gestation from June 2021 to March 2024. Preoperative, perioperative, perinatal, and neonatal outcomes were analyzed and a comparison with other Asian centers was performed.

Results: Patients treated were in advanced stages III-IV of TTTS (86%). Gestational age at FLP was 22.1 ± 2.8 weeks. The perinatal overall survival rate was 64% with a double survivor rate of 57%, a single survivor rate of 14%, and at least one survivor in 71%. The interval between FLP and delivery was 36.6 ± 25.2 days with age at delivery of 27.1 ± 4.3 weeks. Compared to 5 other Asian centers, procedures performed per year ranged from 2.5 to 14.2 cases. Overall fetal survival rates were between 64 to 82%.

Conclusion: Our center’s early experience of treating TTTS with FLP reflects the current conditions of prenatal screening and access to specialized care in the country. Early recognition of TTTS is key to providing patients and their families timely management and support. Devising local standardized assessments for education and performance of FLP, establishing the surgical learning curve, facilitating audits, and initiating research will improve fetal surgery benchmarks in the country.