Fetoscopic laser management of triplet pregnancies complicated by twin-twin transfusion syndrome

Introduction Twin-twin transfusion syndrome (TTTS) may complicate triplet pregnancies with a monochorionic component; however, data on fetoscopic laser ablation (FLA) in this setting remain limited. This study evaluated perinatal outcomes in TTTS-affected triplet pregnancies with at least one monochorionic placenta treated with FLA, and compared these with monochorionic diamniotic (MC/DA) twin pregnancies. Methods We retrospectively reviewed 42 triplet pregnancies complicated by TTTS treated with FLA. Of these, 25 were dichorionic triamniotic (DC/TA, 59.5%) and 17 were monochorionic triamniotic (MC/TA, 40.5%). Antenatal, procedural, and neonatal outcomes were compared with those of 1072 MC/DA twin pregnancies treated with FLA at the same centre. Categorical and continuous variables were compared using the Chi-square/Fisher's exact test and Mann-Whitney U test, respectively; with p < 0.05 considered statistically significant. Proportions are presented with 95% confidence intervals, and subgroup analyses were considered exploratory. Results Quintero stage distribution did not differ significantly between cohorts, and gestational age (GA) at FLA was 20.3 weeks (IQR 18.7-22.3) in triplets and 20.4 weeks (IQR 18.4-23.1) in twins. Procedural complications in triplets were infrequent and did not differ significantly from twins. PPROM rates and laser time did not differ significantly. Survival of unaffected triplet was 88.1%. Among TTTS-affected pairs within triplets, dual neonatal survival was 61.9%, with at least one survivor in 85.7%. Dual survival was more frequent in MC/TA (70.6%) than in DC/TA (56.0%) triplets. Survival outcomes were not statistically different from those of MC/DA twins (dual: 70.1%, at least one 91.6%. The median GA at delivery was 31.8 weeks in triplets and 32.3 weeks in twins. Conclusions Triplet pregnancies with TTTS treated with FLA showed no statistically significant differences in antenatal and neonatal outcomes to MC/DA twins, with high survival rates and low complication rates reported.