OP15.07: Cord occlusion in TTTS: indications and outcome

Abstract

Objectives: The most severe complication in monochorionic (MC) pregnancies is TTTS. Fetoscopic selective laser coagulation (FSLC) is the first choice of treatment but is associated with risk of severe neurodevelopmental morbidity. Studies on outcome after umbilical cord occlusion (UCO) have indicated smaller risk of neurological adverse outcome. Selected TTTS cases have been offered UCO since 2006, as an alternative treatment to FCSL. This study documents indications and short term pregnancy outcome of UCO for TTTS. Methods: A cohort of all 56 MC pregnancies with TTTS, who consecutively underwent UCO between 2004 and 2010 at Rigshospitalet Copenhagen, was included. No exclusion criteria were used. Outcome was evaluated as overall survival per fetus. Survival until four weeks after birth was used. Results: Indications: 52 cases (49 twins, three triplets) underwent UCO as primary treatment, while four were treated secondary to FSLC. Eight cases (14%) had additional structural fetal discrepancies. 45 (80%) of the cases were Quintero stage 3 and 4. Outcome: of the 59 intended survivors there were eight (14%) intrauterine fetal deaths (IUFD) i.e. three within 24 hours after surgery, four within one to four weeks and one 13 weeks after surgery. Median gestational age (GA) at delivery was 34.6 weeks. 70% of patients delivered after 32 weeks. Preterm rupture of the membranes before 25 weeks was associated with three perinatal deaths (5%). Survival rate was 80%. One case was lost to follow up for outcome. Conclusions: Quintero stage 3 was by far the most common Q stage treated with UCO. Nevertheless, our survival rate of 80% is very similar to reports from other investigators reporting on UCO in MC multiples with or/out TTTS. We are aware, that the number of cases in this cohort is limited, but outcome by means of survival and GA at birth is in agreement with the literature and, furthermore, indicates that pregnancy outcome after UCO on TTTS is similar to outcome after UCO without the presence of TTTS. Long term outcome is ongoing in the presented group.