EP20.06: Initial experience of a fetal medicine service in the accomplishment of fetoscopy for the treatment of feto‐fetal transfusion syndrome

Abstract

Feto-fetal transfusion syndrome (FFST) is an exclusive complication of monochorionic twin pregnancies and occurs in about 15% of these cases due to unbalanced blood exchange between fetal circulations through placental anastomoses. Diagnosis is made by ultrasonography, based on the binomial oligo-polydramnium, and the disease is classified in stages (Quintero standardisation). It presents high perinatal morbidity and mortality. Treatment chosen was fetoscopy by laser photocoagulation of the vascular anastomoses of the chorionic plaque. The aim of this study is to present the initial experience of Federal University of São Paulo fetal medicine service in this type of procedure. A prospective observational study was carried out. 16 and 26-week-old monochronic diamniotic pregnancies diagnosed with FFST stages II, III, IV or V of Quintero were included. These patients were submitted to fetoscopy for laser photocoagulation of the vascular anastomoses of placental chorionic plaque (SOLOMON technique). The study was approved by the ethics committee and patients selected signed a consent form. Twenty four pregnant women with FFST underwent fetoscopy between November 2012 and October 2016. Gestational age of the procedure ranged from 16 to 26 weeks (average 20.75 weeks). Time of procedure ranged from 30 minutes to 98 minutes (average 51.9 minutes). Age of delivery ranged from 22 to 37 weeks (average 30.54 weeks). In 6 cases (25%), septostomy occurred iatrogenically. In 4 cases (16.7%) bleeding occurred during the laser. In 21 cases (87.5%) there was at least one live fetus until delivery; And in 45.8% (11) of the pregnancies there were two fetuses alive until delivery. In 4 cases (16.7%) there was FFST recurrence and in 1 case (4.2%) we observed development of the anemia-polycythemia sequence. Development of new centres specialised in fetoscopy is very important. Our results approximate the data described in the literature.