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Long‐term indomethacin therapy after laser surgery for TTTS. Worth the effort?

Fetal endoscopic surgery is a life-saving procedure for severe cases of TTTS. Over 25,000 cases of laser surgery for TTTS have been published since 1991, achieving survival rates of over 75% overall and 90% for at least one twin. However, preterm premature rupture of the membranes (PPROM) and birth before 32 weeks follow laser surgery in 20-50% of cases. This is due to the insult to the membranes caused by the trocar and the surgical procedure. Considerable efforts have been made for secondary prevention of PPROM, but despite more than 15 years of work in this field, clinical validation is lacking.