OP24.05: Management of high‐order multiples complicated by TRAP sequence

Abstract

Objectives: To describe early changes in fetal cardiac function after laser treatment in severe twin–twin transfusion syndrome (TTTS). Methods: A prospective study was conducted over a fivemonth period. Cardiac function was assessed in 49 consecutive monochorionic pregnancies presenting with severe TTTS and referred for fetoscopic selective laser coagulation (FSLC) of placental anastomoses as first-line treatment. Echocardiography was performed on admission and after laser treatment (median = 1 day, IQR = 1–3). The studied parameters included cardiac output, myocardial performance index, shortening fraction (SF), and heart dimensions. Results: Median gestational age was 21 weeks (IQR = 19–23). Distribution across Quintero stages was as follow: 32.7%, 18.4%, 46.9% and 2.0% for stages 1, 2, 3 and 4 respectively. Cardiac output significantly increased after laser treatment in both donor (+33%) and recipient twins (+24%). In the recipient twin, a significant increase in LV SF was also found. The increase in cardiac output was not significantly correlated with Quintero stage, the volume of amniotic fluid drained, or gestational age. Conclusions: As early as 24 h after laser treatment, a significant increase in systolic function was found in both twins. These changes seem to be unrelated to initial severity of the syndrome.