Selective Fetoscopic Laser Photocoagulation (SFLP)

Selective Fetoscopic Laser Photocoagulation (SFLP)

In complicated cases of Twin-to-Twin Transfusion Syndrome (TTTS), minimally invasive surgery can offer the best chance of having two healthy babies. This surgery, known as Selective Fetoscopic Laser Photocoagulation (SFLP), is performed in utero between 16 and 26 weeks of pregnancy. The goal of this surgery is to correct the blood-sharing imbalance caused by TTTS.

What to Expect

Preparing for the procedure

  • Tell your healthcare provider about all medicines you take including over-the-counter medicines, vitamins and pain medicines.
  • Don't put anything in your vagina for 24 hours before the procedure. Don't have sex.
  • If instructed, don't eat or drink anything for at least 8 hours before the procedure including water. If you have diabetes, ask your provider for additional instructions.

The day of the procedure

  • An IV (intravenous) line is placed in your hand or arm. It sends fluids and medicine into your body.
  • You will be given spinal or epidural anesthesia. This is medicine to keep you free of pain. This will make you numb from the waist down. Depending on what type of anesthesia you get, you may be relaxed, drowsy, or fully asleep during the procedure.
  • You may also be given medication to prevent contractions or labor
  • The healthcare provider starts with an ultrasound examination to find the best insertion site for the fetoscope.
  • A small skin incision will be made to insert the fetoscope into the uterus under continuous ultrasound guidance.
  • Once inside the uterus, a laser fiber is inserted into the fetoscope. The placental vessels that cause the TTTS are coagulated under direct vision.
  • At the end of the procedure, if necessary, excess amniotic fluid may be drained through the fetoscope.
Selective Fetoscopic Laser Photocoagulation procedure
A tiny laser fiber is used to stop the blood flow in the vessels on the shared placenta going between the babies with TTTS

    After the procedure

    • You will be taken to a room to recover from the anesthesia. Nurses will check on you as you rest.
    • You will be watched for signs of preterm labor. You will be given medicine that helps prevent preterm labor.
    • You will stay overnight in a hospital room. This is to make sure you don't go into preterm labor.
    • The next day, you will have an ultrasound.
    • When you leave the hospital, have an adult friend or family member drive you home.

    Recovering at Home

    • You might experience some mild cramping. Notify your healthcare provider if you are having intense or regularly timed cramping.
    • Limit your activity. Avoid exercise, lifting, and any activity that causes more uterine cramping. Ask your healthcare provider when you can increase your activity or exercise.
    • Avoid sex or inserting anything in the vagina until you discuss with your healthcare provider.
    • Keep adequate fluid intake throughout the day (8 glasses of water per day).
    • Incision care: The steri strips and glue will fall off on their own after a few days. Keep the incision site dry and clean. Do not pick the steri strips off or scrub the incision site.
    • Return to work: Ask your healthcare provider when you can go back to work.

    Follow Up Care

    For at least the next 4 to 6 weeks, you will be scheduled for weekly ultrasounds to look for resolution of TTTS, which is typically complete in two weeks. If receiving ultrasounds with your local MFM, you may need to be reevaluated at the Fetal Center dependent on findings.

    Because the surgery is minimally invasive, it does not affect the type of delivery required or future childbearing. After birth, children with TTTS during pregnancy are at increased risk for neurodevelopmental delay. Our Developmental Medicine team may follow up with your child’s development.

    Risks & Complications

    When to call your healthcare provider

    Call your healthcare provider if you experience any of the following:

    • A fever of 100.4ºF (38ºC) or higher, or as advised by your healthcare provider
    • Contractions or intense stomach cramping
    • Cramping that is regularly timed or spaced about the same distance apart
    • Fluid leaking from the vagina
    • Bleeding or spotting of blood from the vagina
    • Back or stomach pain
    • Signs of infection at the skin incision site, such as redness or swelling, warmth, worsening pain, or bad-smelling drainage.
    • Abdomen or stomach rapidly getting bigger or becoming more uncomfortable

    Risks and possible complications of Selective Fetoscopic Laser Photocoagulation (SFLP)

    The procedure is considered safe. But like all procedures, it has some risks. These include: bleeding and infections, preterm contractions, labor or delivery, premature rupture of membranes (PROM), pregnancy loss, injury to your bladder or other nearby organs and risks of anesthesia.

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