OP06.09: Maternal transient tachycardia following treatment of twin‐to‐twin transfusion syndrome by laser ablation of placental vascular anastomoses

Abstract

Objectives: A significant subset of patients presents with new-onset maternal tachycardia (heart rate >100 beats per minute) 24 hours after laser coagulation of placenta anastomoses for twin-to-twin transfusion syndrome (TTTS). The clinical and pathophysiologic implications of this tachycardia are unknown. We thus investigated the relation between maternal clinical, surgical and laboratory findings and postoperative maternal tachycardia after fetoscopic laser for TTTS. Methods: Demographic data, surgical characteristics, maternal perioperative vital signs as well as hematologic, coagulation and biochemistry blood work were retrospectively reviewed in 311 patients undergoing fetoscopic laser ablation of placental anastomoses for TTTS. Results: Fifty-four women (17.4%) had new-onset persistent tachycardia 24 hours after laser. Simultaneously, a significant drop of both systolic (9mmHg) and diastolic (−8 mmHg) blood pressure (BP) was observed (P 3,000 mL (Odds Ratio [OR] 2.0, 95% Confidence Interval [95% CI] 1.1–3.9) and indomethacin use in the post-laser period (OR 0.3, 95% CI 0.1–0.6) as the only variables independently associated with maternal postoperative tachycardia. Maternal tachycardia did not lead to any changes in clinical management. Conclusions: Feto-maternal volume shifts as well as changes in intraabdominal pressure after fetoscopic laser cause a drop in maternal BP and an increase in maternal HR. These changes may be affected by the use of Indomethacin through its effects on maternal pain and diuresis.