416: Maternal obesity and outcomes with laser therapy for twin twin transfusion syndrome

Abstract

To determine if maternal obesity, as defined by BMI ≥ 30, negatively impacts the technical aspects and pregnancy outcomes in women treated with selective laser photocoagulation of placental communicating vessels for twin-twin transfusion syndrome (TTTS). Retrospective review of women undergoing laser for TTTS from June 1, 2005 – March 31, 2010. Outcomes were stratified based on maternal BMI < 30 and ≥ 30. Data obtained included gestational age at laser, placental location, Quintero stage and CHOP cardiac score at laser, operative and anesthesia times, procedure to delivery interval, gestational age at delivery, survival to birth and to discharge. Women with increased BMI were assessed intraoperatively for the need to alter technical approach. Technical changes included adjustments in patient positioning, lighter conscious sedation and longer introducers when the abdominal wall to amniotic sac distance was measured to be > 4.5 cm. Statistical analysis included chi-square for categorical variables and student's t test for continuous variables with p< 0.05 being significant. A total of 153 women underwent laser for TTTS during the study period. Of those, 100 (65%) had a BMI of < 30 and 53 (35%) had a BMI ≥ 30. There were no differences in the gestational age at laser, Quintero stage, CHOP cardiac score, anesthesia or operative times, laser to delivery interval, gestational age at delivery or survival outcomes between the two groups, as represented in the table. There were no technical failures as a result of BMI ≥ 30.Tabled 1All patientsBMI < 30 N=100BMI ≥ 30 N=53P valuePlacenta Location0.97Anterior58 (38%)38 (38%)20 (37.7%)Posterior95 (62%)62 (62%)33 (62.3%)TTTS Stage 285 (55.6%)51 (51%)34 (64.2%)0.20Stage 361 (39.9%)43 (43%)18 (34%)Stage 47 (4.6%)6 (6%)1 (1.8%)CHOP cardiac score6.9 (± 4.5)6.9 (± 4.5)6.8 (± 4.5)0.93Gestational age at laser (weeks)20.9 (± 2.0)20.8 (± 2.1)21.1 (± 1.8)0.41Anesthesia time (minutes)117.9 (± 27.8)120.3 (± 28)113.8 (± 27.2)0.14Operative time (minutes)72.5 (± 23.1)73.6 (± 24)70.4 (± 21.3)0.41Gestational age at delivery (weeks)32.6 (± 4.7)32.6 (± 4.6)32.7 (± 4.9)0.94Procedure to delivery interval (days)82.5 (± 35.8)82.9 (± 34.6)81.6 (± 38.2)0.84Survivors to Live Birth0.7808 (5.2%)5 (5%)3 (5.7%)126 (17%)18 (18%)8 (15.1%)2118 (77%)76 (76%)42 (79.3%)31 (0.65%)1 (1%)0 (0%)Survivors to Discharge0.51014 (9.5%)8 (8.33%)6 (11.7%)127 (18.4%)20 (20.83%)7 (13.7%)2105 (71.4%)67 (69.8%)38 (74.5%)31 (0.68%)1 (1.04%)0 (0%) Open table in a new tab Using appropriate technical adjustments, outcomes for obese women undergoing laser for TTTS are similar to non-obese women.