Author:

Keywords:

Anemia, Blood Flow Velocity, Cerebrovascular Circulation, Female, Fetal Diseases, Fetofetal Transfusion, Fetoscopy, Humans, Laser Coagulation, Pregnancy, Prevalence, Remission Induction, Time Factors, Science & Technology, Life Sciences & Biomedicine, Obstetrics & Gynecology, feto-fetal transfusion syndrome, laser coagulation, fetoscopy, anemia, middle cerebral artery peak systolic velocity, recurrence, discordant hemoglobin levels, MONOCHORIONIC TWIN, PLACENTAL VESSELS, PREGNANCIES, DIAGNOSIS, SURGERY, ANEMIA, POLYHYDRAMNIOS, PATHOGENESIS, RECIPIENT, 1114 Paediatrics and Reproductive Medicine, Obstetrics & Reproductive Medicine, 3215 Reproductive medicine

Abstract:

OBJECTIVE: This study was undertaken to report on the prevalence and management of late complications in twin-to-twin transfusion syndrome (TTTS) treated by laser therapy when both twins are alive 1 week after surgery. STUDY DESIGN: A total of 151 consecutive TTTS cases were treated by selective fetoscopic laser therapy. Cases in which both twins were alive 1 week after surgery were followed up with ultrasound and Doppler examination, including middle-cerebral artery peak systolic velocity measurement (MCA-PSV). RESULTS: In the 151 cases treated with laser, both twins were still alive 7 days after the procedure in 101 cases. Intrauterine death of 1 and both twins occurred in 7 and 1 cases, respectively. Recurrence of TTTS with the polyhydramnios-oligohydramnios sequence occurred in 14 (14%) cases. In another 13 (13%) cases, amniotic fluid remained normal in both sacs, but MCA-PSV increased above 1.5 MoM in 1 twin and decreased concomitantly below 0.8 MoM in the co-twin. This was related to anemia and polycythemia, respectively, and resulted from unidirectional feto-fetal blood transfusion, mainly from former recipients into former donors. Late complications were managed accordingly by repeat laser, amnioreduction, cord coagulation, intrauterine blood transfusion, or elective delivery. CONCLUSION: MCA-PSV Doppler measurements are useful in the follow-up of double survivors to detect and manage late complications after selective laser therapy.