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Twin-to-twin transfusion syndrome(TTTS) is associated with a high risk of perinatal mortality and morbidity. The objective of this review was to evaluate the safety and effectiveness of fetoscopic laser coagulation of placental vascular anastomoses for the treatment in twin-to-twin transfusion syndrome. We conducted a systematic review of the literature searching the following databases: Ovid-MEDLINE, Ovid-EMBASE, the Cochrane Library and Eight domestic databases including KoreaMed. Randomized controlled trials and Cohort studies of comparing laser coagulation with amnioreduction, septostomy, and selective feticide were included. Two reviewers independently selected data in standardized form and assessed the methodological quality. Quality evaluation was performed by SIGN method. Total 10 studies(3 RCT and 7 Cohort studies) wer e included. Fetoscopic Laser coagulation was significantly less perinatal death(relative risk(RR) 0.76; 95% CI 0.61 to 0.95, I2=58%,p=.04),less neonatal death (RR 0.31 ;95%CI 0.21-0.45,I2=0,p<.0001) and less neurologic morbidity (RR 0.36; 95%CI 0.19-0.68,I2=22,p=.001) than in pregnancies treated with amnioreduction. There were observed no difference between laser coagulation and amino reduction in terms of complications (PPROM, PROM, placental abruption, Intra -abdominal leakage of amniotic fluid etc.). In a systematic review, laser coagulation of placental vascular anastomoses seems to be more effective than amnioreduction in the treatment of twin-to-twin transfusion syndrome with less associated perinatal mortality, neonatal mortality and neonatal morbidity.
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