P06.05: Hemodynamics of fetuses after fetoscopic laser surgery with twin–twin transfusion syndrome

Abstract

Objectives: The aim of this study was to evaluate hemodynamics in each twin fetuses of twin–twin transfusion syndrome (TTTS) pregnancy after fetoscopic laser surgery. Methods: Over a period of 3 months (June to September 2009) 18 pregnant women underwent fetscopic laser surgery (FLS) for TTTS. We measured umbilical venous volume flow (UVF) dynamics and combined cardiac output (CCO) of both fetuses before FLS and on day 1.4.7.14.21.28 after FLS. Results: All 36 fetuses in 18 cases were alive after FLS. The CCO of both donor and recipient fetuses elevated and achieved a peak within 1–4 days after FLS and decreased to normal level of CCO by one week. Thereafter, the levels of CCO in both fetuses were unchanged until their term. Donor’s UVF achieve a peak within 1–4 days after FLS and decreased to a little higher level than those before FLS. Recipient’s UVF gradually decreased to the normal level without making a peak after FLS. Conclusions: The changes of UVF in donor and recipient demonstrate the alternation of placental circulating blood volume by coagulating the connecting vessels. The increase of CCO in the recipient was not explained by the alternation of placental circulating blood volume by FLS. The dynamics of CCOs in twins following FLS can be caused by a different mechanism. The further study needs to clarify this question.