Experience of repeated fetoscopic laser coagulation of placental anastomoses in case of recurrence of twin-to-twin transfusion syndrome

Abstract

Recurrence of twin-to-twin transfusion syndrome (TTTS) after fetoscopic laser coagulation (FLC) of placental anastomoses is unfavorable complication. Multiparous woman 34 years old in TTTS stage 2 was performed FLC of 8 arteriovenous anastomoses of the placenta followed by amnioreduction of 1000 ml on the gestational age of 22 weeks and 2 days. At gestational age of 24 weeks 6 days was revealed a recurrence of the TTTS, with considerable polyhydramnion of recipient and anhydramnion of the donor, a repeated FLC of 5 residual placental anastomoses was performed and amnioreduction of 2000 ml at 25 weeks 1 day of gestation. On the fifth day was normalized the amount of amniotic fluid of both fetuses. At 32 weeks of gestation spontaneously was began the birth, the weights of newborns were 1560 and 1600 g, both had Apgar score 8/9. Respiratory therapy continued for 7 hours at the second newborn and for 13 hours at the first newborn girl after transferring to the ICU. The signs of the respiratory failure were not observed. There were no differences between complete blood counts. This clinical case confirms the possibility of effective correction of recurrence TTTS with the help of repeated FLC of placental anastomoses.