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Poster Session 3

Category: Fetal Intervention

Poster Session 3

(817) Solomon Technique Increases Risk for Extreme Preterm Birth after Laser Surgery for Twin-Twin Transfusion Syndrome

Thursday, February 12, 2026

10:30 AM - 12:00 PM

Submitting Author and Presenting Author(s)

Jimmy Espinoza, MD, MSc

Professor
UTHealth Houston Fetal Institute; Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States

Coauthor(s)

ML

Magdalena Litwińska, MD

Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
Warsaw, Mazowieckie, Poland
Ramesha Papanna, MD, MPH

Professor
University of Texas Health Science Center in Houston, McGovern Medical School
Houston, Texas, United States
Anthony Johnson, DO

Professor
UTHealth Houston Fetal Institute; Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Sami Backley, MD

Clinical Fellow PGY 9
Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Felicia V. LeMoine, MD (she/her/hers)

Fetal Intervention Fellow
Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
SZ

Sen Zhu, PhD

UTHealth Houston Fetal Institute; Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
DL

Dejian Lai, PhD

Professor
Department of Biostatistics, School of Public Health at UTHealth Houston
Houston, Texas, United States
RM

Randy Mohtar, BS

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles
Los Angeles, California, United States
AL

Arlyn S. Llanes, MHA, RN

Keck School of Medicine of USC, University of Southern California
Keck School of Medicine of USC, University Of Southern California, California, United States
Ramen H. Chmait, MD (he/him/his)

Director, Los Angeles Fetal Surgery; Professor, Department of Obstetrics and Gynecology
Keck School of Medicine of USC, University of Southern California
Keck School of Medicine of USC, University Of Southern California, California, United States

Objective:
To explore associations between Solomonization during laser surgery and adverse pregnancy outcomes in monochorionic diamniotic (MCDA) pregnancies complicated by twin-twin transfusion syndrome (TTTS).

Study Design:
This retrospective cohort study included MCDA twin pregnancies complicated by TTTS that underwent laser surgery from 2006-2023 at two centers. Primary outcome was delivery < 4 weeks after laser surgery. Secondary outcomes were delivery < 28 weeks and placental abruption. Cases of dual fetal death and no laser technique or delivery data were excluded. Multivariable robust Poisson regression models were used to estimate relative risks (RR) for outcomes adjusted for TTTS stage, selective fetal growth restriction, cervical length < 25 mm, and premature prelabor rupture of membranes (PPROM), among other confounders. Cox regression was used to evaluate Solomonization’s effect on surgery-to-delivery interval. A p< 0.0056 was used after Bonferroni correction.

Results:
Of 1,680 TTTS cases, 80 were excluded, with exclusions occurring equally between study groups. Adverse pregnancy outcomes were more frequent with Solomonization (Tables), which was independently associated with delivery < 4 weeks after surgery (RR: 1.98; 95% CI: 1.38-2.84; p< 0.001), delivery < 28 weeks (RR: 1.60; 95% CI: 1.23-2.06; p< 0.001), placental abruption (RR: 1.91; 95% CI: 1.31-2.80; p=0.001), and shorter surgery-to-delivery interval (hazard ratio: 1.42; 95% CI: 1.28-1.58; p< 0.001). The Solomon group exhibited increased laser time, higher laser energy consumption, elevated PPROM rates, earlier gestational age at delivery, and reduced 30-day survival rate of at least one twin (Table 2). Anterior placenta, surgeon, entry technique, cannula size, fetoscope type, or amnioinfusion volume were not associated with the primary outcome.

Conclusion:
The Solomon laser technique is associated with increased risk of delivery within four weeks after laser surgery, delivery < 28 weeks’ gestation, shorter surgery-to-delivery interval, and placental abruption in MCDA pregnancies complicated by TTTS.