OP26.04: Low cerebroplacental ratio can predict subsequent fetal demise of donor or smaller twin with abnormal umbilical artery flow after fetoscopic laser surgery

Abstract

To evaluate the utility of cerebroplacental ratio (CPR) for prediction of subsequent fetal demise (FD) after fetoscopic laser photocoagulation of placental communication (FLP) in cases with Twin–twin transfusion (TTTS) or selective intrauterine growth restriction (sIUGR), complicated with absent end-diastolic flow in umbilical artery (UA-AEDF). FLP were performed from 2015 to 2017. CPR (MCA-PI/UA-PI) was recorded within 24 hours before FLP and postoperative 1, 4-7 or 9-15 days. All patient was followed until neonatal period. Relation between the perinatal outcome, especially FD of smaller twin, and values of CPR were analysed. Three cases of TTTS stage 3 and 10 cases of sIUGR were treated with FLP. Median gestational age at FLP was 19.3 (16.0-23.1). Eight case (62%) showed two neonatal survivals and other 5 twins (38%) were complicated with FD of donor or smaller twin at 31, 39, 80, 84 and 105 days after FLP, respectively. All recipient or larger twins survived after FLP. Preoperative CPR showed no significant difference between two groups with or without FD of donor or smaller twin. CPR of 8 survived donor or smaller twin showed marked increases after FLP, in which all CPR values increased at least more than 0.57 at the point of around 2 weeks after FLP. On the other hand, all 5 twins resulted in FD showed low CRP value, which remained less than 0.57 until 2 weeks after FLP. In compromised monochorionic twins showing UA-AEDF in donor or smaller twin, continuation of lower CPR in donor or smaller twin after laser surgery can predict the subsequent fetal demise. Such low CPR value might reflect severe insufficient placental function of remained placental territory in donor or smaller twins.