Abstract
Twin-to-twin transfusion syndrome (TTTS) in monochorionic-diamniotic twin pregnancies usually requires fetoscopic laser ablation (FLA) followed by amniodrainage (AD). Perioperative maternal hemodynamic changes and hemodilution have been observed. Little is known about the underlying pathophysiology. We aimed to evaluate the impact of high volume amniodrainage on intrauterine pressure, placental thickness and maternal blood characteristics. A total of 18 cases of TTTS were included in this prospective pilot study. All patients were treated with FLA and subsequent AD. Intrauterine pressure and placental thickness were assessed before, during and after amniodrainage. Maternal hemoglobin, hematocrit and serum albumin were measured at admission and 24 h after the intervention. Amniodrainage led to a decrease in mean intrauterine pressure (from 30.1 ± 8.1 mmHg to 17.6 ± 3.6 mmHg (p < 0.001)) and an increase in mean placental thickness (from 16.8 ± 6.4 mm to 31.83 ± 8.64 mm (p < 0.001)). There was a positive correlation between changes in placental thickness and the amount of amniodrainage during intervention (Pearson’s Rho 0.73; p = 0.001). Hematocrit decreased from 33.4 ± 3.8 (%) to 28.4 ± 3.5 (%), i.e., an increase in relative blood volume by 18 ± 10.2% (p < 0.001). Albumin decreased from 37.9 ± 0.9 g/L to 30.7 ± 2.2 g/L, i.e., an increase in relative plasma volume by 24 ± 8.1% (p < 0.001). Amniodrainage leads to uterine decompression, increased placental thickness and subsequent maternal hemodilution. We propose the term “amniodrainage-induced circulatory dysfunction” for these specific maternal hemodynamic changes in the treatment of twin-to-twin transfusion syndrome.
Highlights
Twin-to-twin transfusion syndrome (TTTS) complicates approximately 10% of monochorionicdiamniotic (MCDA) twin pregnancies [1]
Clinical signs suggestive of maternal hemodilution were described in cases of mid-trimester TTTS managed by fetoscopic laser ablation (FLA) and subsequent amniodrainage, providing evidence that such interventions have a significant impact on the maternal compartment [5,6,7]
The study included 18 women with TTTS treated by FLA and subsequent amniodrainage
Summary
Twin-to-twin transfusion syndrome (TTTS) complicates approximately 10% of monochorionicdiamniotic (MCDA) twin pregnancies [1]. Fetoscopic laser ablation (FLA) of placental anastomoses is currently the best treatment available for TTTS, yielding double survival rates of more than 60% in large recent series. In contrast to the high number of scientific reports on fetal outcome and treatment options, data on maternal hemodynamic changes or adverse side effects following FLA procedures are scarce. Clinical signs suggestive of maternal hemodilution were described in cases of mid-trimester TTTS managed by FLA and subsequent amniodrainage, providing evidence that such interventions have a significant impact on the maternal compartment [5,6,7]. A variety of observations including maternal hemodynamic adaptations, decrease in intrauterine pressure and increase in placental volume have been described following high volume amniodrainage [8,9]. The mechanisms leading to these complications are still not comprehensively understood
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