OC122: Operative and postoperative complications in 120 foetoscopies for laser treatment in twin to twin transfusion syndrome (TTTS)

Abstract

To evaluate the incidence and types of operative and postoperative significant complications following laser treatment in TTTS. Retrospective analysis of all the cases of TTTS treated by laser coagulation of placental anastomoses between 1999 and 2003. Type of anesthesia, maternal discomfort, uterine contractions, intraoperative bleeding, placental abruption, rupture of membranes, chorioamnionitis and preterm delivery were reviewed. These were correlated to the outcome of pregnancy. 120 laser foetoscopies were reviewed. Laser was performed at a median gestation of 20 weeks [15–26]. Local anesthesia together with oral flunitrazepam was used in all cases. There was no maternal death. There was no need for intensive care or blood transfusion in any of the cases. Postoperative maternal discomfort at the trocar insertion site occurred in 9%. Chemical peritonitis due to amniotic fluid leakage occurred in 14%. Premature rupture of the membranes (PROM) occurred in 33 cases (27.5%): 12 occurred within 7 days and 31 after 7 days of laser. 5/33 occurred after 32 weeks. There were 3 cases of chorioamnionits (2.5%). Vaginal bleeding occurred in 6 cases (5%) that were followed by PROM in 4 cases within a month. There were 2 patients with placental abruption, only one clinically diagnosed; the other case was found on pathological examination after spontaneous delivery at 24 weeks. (14%) had spontaneous delivery before 24 weeks and 8 patients had spontaneous delivery before 34 weeks (7%). Intraoperative bleeding, cloudy vision through amniotic fluid and anterior placenta were significantly more frequent in patients that later presented IUFD or PROM (x2, p ≤ 0.05). Median Gestational age at delivery was 32 weeks, with a 45% of caesarean section rate. Fetoscopic laser treatment of TTTS is a minimally invasive procedure with few maternal complications. PROM remains a challenge to be addressed.