Prevalence and management of late fetal complications following successful selective laser coagulation of chorionic plate anastomoses in twin-to-twin transfusion syndrome.
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.


METHODS
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.


CONCLUSIONS
MCA-PSV Doppler measurements are useful in the follow-up of double survivors to detect and manage late complications after selective laser therapy.
Robyr
Romaine
R
Department of Obstetrics and Gynecology, Paris-Ouest University, CHI Poissy-St-Germain, France.
Lewi
Liesbeth
L
Salomon
Laurent J
LJ
Yamamoto
Masami
M
Bernard
Jean-Pierre
JP
Deprest
Jan
J
Ville
Yves
Y
D000740:Anemia / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D001783:Blood Flow Velocity; D002560:Cerebrovascular Circulation; D005260:Female; D005315:Fetal Diseases / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005330:Fetofetal Transfusion / Q000150:complications / Q000601:surgery*; D005332:Fetoscopy; D006801:Humans; D017075:Laser Coagulation / Q000379:methods; D011247:Pregnancy; D015995:Prevalence; D012074:Remission Induction; D013997:Time Factors