Johns Hopkins Medicine

Updates in Fetal Therapy

The webinar presented the latest fetal‑therapy updates, concentrating on monochorionic twins and their associated complications—twin‑to‑twin transfusion syndrome (TTTS), selective fetal growth restriction (SFGR), twin anemia‑polycythemia sequence (TAPS), and fetal anemia. Dr. Urebe outlined a rigorous surveillance protocol: detailed nuchal translucency, bi‑weekly MVP and Doppler assessments from 16 weeks, anatomy scan at 20 weeks, fetal echocardiogram at 22 weeks, and continued Q2‑week monitoring. Key insights included the use of the Quintero staging system to triage TTTS referrals, with stages 3‑4 requiring emergent care. Laser therapy has evolved from non‑selective to selective and now Solomon laser, each iteration raising survival rates—TTTS‑only cases show ~92 % double‑fetal survival versus ~80 % when SFGR co‑exists. SFGR was categorized into three types based on umbilical artery Doppler patterns, guiding expectant versus interventional management. Size discordance at diagnosis emerged as a strong predictor of donor demise after laser. Notable data points highlighted that 55 % of treated TTTS cases were isolated, while 30 % had overlapping SFGR, with corresponding survival differences. The Solomon laser’s complete equatorial coagulation aims to eliminate recurrence risk. For TAPS, exchange transfusion—donor transfusion followed by recipient partial exchange—can buy roughly four weeks of gestation, mitigating prematurity‑related morbidity. These findings underscore the necessity for obstetric teams to adopt intensive monitoring, precise staging, and the most advanced laser technique available. Recognizing early size discordance and employing temporizing measures like exchange transfusion can markedly improve perinatal outcomes for high‑risk monochorionic pregnancies.