Abstract
Twin-to-twin transfusion syndrome (TTTS) is a challenging complication in monochorionic diamniotic (MCDA) twins. Intrauterine interventions, such as fetoscopic laser ablation and cord occlusion followed by amniodrainage, are established treatments. Little is known about maternal complications and hemodynamics following these interventions. We performed a retrospective analysis of maternal procedure-related complications and the impact of such procedures on maternal hemodynamics and blood characteristics. Within the study period, 100 women with severe TTTS treated by fetoscopic laser ablation (FLA) or cord occlusion (CO) were identified. Clinically relevant maternal complications were reported in four (4%) cases. There was a significant decrease in hemoglobin, hematocrit, and albumin between admission and postoperative measurements (all p < 0.001). Systolic and diastolic blood pressure, as well as maternal heart rate, decreased from time of skin suture to postoperative measurements (all p < 0.001). Within a 24 h interval, there was a positive correlation between hematocrit (Spearman’s rho 0.325; p = 0.003), hemoglobin (Spearman’s rho 0.379; p < 0.001), and albumin (Spearman’s rho 0.360; p = 0.027), and the amount of amniodrainage during the intervention. Maternal procedure-related complications are relatively rare. Significant hemodynamic alterations and maternal hemodilution are common clinical findings following intrauterine interventions.
Highlights
Twin-to-twin transfusion syndrome (TTTS) complicates about 10% of monochorionic diamniotic twin pregnancies [1,2]
Data of all women with monochorionic diamniotic twin pregnancies treated by fetoscopic laser ablation (FLA) or cord occlusion (CO) in the case of severe TTTS were selected, while those who underwent intrauterine therapy for indications other than advanced TTTS were excluded from the analyses
100 women with severe TTTS treated by FLA or CO were identified
Summary
Twin-to-twin transfusion syndrome (TTTS) complicates about 10% of monochorionic diamniotic twin pregnancies [1,2]. The amount of amniotic fluid drained was linked to the degree of changes between pre- and postoperative hematocrit and hemoglobin levels [21] It seems that the maternal cardiocirculatory system is stressed by high-volume amniodrainage in particular, leading to a decrease in mean arterial blood pressure and total vascular resistance, and an increase in cardiac output and stroke volume. These hemodynamic alterations were pronounced within the first six postoperative hours and persisted at least 24 h after treatment [22]. We sought to investigate maternal procedure-related complications following intrauterine interventions for TTTS as well as the impact of such procedures on maternal hemodynamics
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