An interventional study of Fetoscopic Laser Photocoagulation in Twin to Twin Transfusion, sponsored by Baylor College of Medicine. Recruiting at 1 site in United States. Open to female participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-03-04.
Sponsored by Baylor College of Medicine · Not applicable, Interventional, and Treatment
The purpose of this study is to evaluate whether the entry technique surgeons use to get inside the uterus to perform fetoscopic laser photocoagulation for twin-to-twin transfusion syndrome has an effect on the rates of chorioamniotic membrane separation.
Patients who choose to undergo fetoscopic selective laser photocoagulation (SFLP) at Texas Children's Fetal Center will be offered participation in this research study by study investigators. Description of study rationale and design and a focused interview by the study coordinator to afford potential participants a formal opportunity to examine what they have learned about the research study in the course of their evaluation and discuss how they feel about enrolling in the research study. Once the patient is deemed eligible the informed consent process will be reviewed. If patients elect to participate in the study, informed consent will be obtained, and participants will be provided a copy of the signed consent.
After consent has been obtained, participants will be randomized into two groups ("direct entry" and "Seldinger technique").
Procedure: Selective laser photocoagulation (SFLP) is standard of care for the treatment of complicated monochorionic twin pregnancies. Entry into the uterus for SFLP is achieved under ultrasound guidance using one of two accepted methods, direct entry or the Seldinger technique. Intravenous sedation with local anesthesia at the site of insertion has been found to provide sufficient maternal anesthesia for the procedure.
Group I - Direct entry: The surgeon will gain access to the uterus by inserting a sharp trocar through a small incision in the skin. After access has been established, the trocar is removed and a small tube called a cannula is left in place.
Group II - Seldinger technique: The surgeon will gain access to the uterus by inserting needle through a small incision in the skin and run a guide wire through the needle so a thin tube called a cannula can be placed over the wire.
Follow-Up:
Participants will be monitored after the procedure and upon discharge from the hospital they are free to resume care with their primary doctor. Investigators will collect follow-up data on the health of the participant and the babies until the babies turn one month old.
Exclusion Criteria:
Surgeons will access the uterus to perform fetoscopic laser photocoagulation by inserting a sharp trocar through a small incision in the skin. The trocar is then removed and a small tube called a cannula is left in place.
Procedure: Fetoscopic Laser Photocoagulation
Surgeons will access the uterus to perform fetoscopic laser photocoagulation by inserting needle through a small incision in the skin and running a guide wire through the needle so a thin tube called a cannula can be placed over the wire.
Procedure: Fetoscopic Laser Photocoagulation
Patients who choose to undergo fetoscopic selective laser photocoagulation for complicated monochorionic-diamniotic twin pregnancies with twin-to-twin transfusion syndrome will be offered participation in the study. All participants will undergo selective laser photocoagulation and entry into the uterus will be achieved using one of two accepted methods, either direct entry or the Seldinger technique.
Rate of Immediate Chorioamniotic Membrane Separation (CAS)
Number of participants that have chorioamniotic membrane separation within 24 hours of the procedure.
Time frame: Up to hospital discharge post-procedure (up to 5 days)
Rate of Chorioamniotic Membrane Separation (CAS)
Number of participants that have chorioamniotic membrane separation outside the first 24 hours hours following the procedure
Time frame: From the post-surgical period (outside the first 24 hours) until delivery, up to 25 weeks
Gestational Age at Delivery
Gestational age at the time of delivery
Time frame: At delivery
Preterm Birth
Number of participants that deliver at \<37 weeks gestation
Time frame: At delivery
Procedure to Delivery Interval
Days between the participant's procedure and when the babies are delivered
Time frame: At delivery
Placental Abruption
As measured by presence in medical record
Time frame: Up to hospital discharge post-procedure (up to 5 days)
Chorioamnionitis
As measured by presence in medical record
Time frame: Up to hospital discharge post-procedure (up to 5 days)
Septostomy
As measured by presence in medical record
Time frame: Up to hospital discharge post-procedure (up to 5 days)
Preterm Premature Rupture of Membranes (PPROM)
As measured by presence in medical record
Time frame: At delivery
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Baylor College of Medicine