P21.01: Is there an optimal gestational age for delivery following fetoscopic laser coagulation of chorionic plate?

Abstract

To describe the rationale underlying the timing of elective delivery following fetoscopic selective laser coagulation (FSLC) for twin–twin transfusion syndrome (TTTS). All consecutive cases of TTTS treated by FSLC over a 7-year period. Unexpected prenatal events included dual demise, single demise > 7 days after surgery and without Doppler anomalies, anemia-polycythemia, recurrence of TTTS, chorioamnionitis, placental abruption/massive bleeding during follow-up. Perinatal morbimortality was defined as death or severe neurological damage at 28 days or discharge from NICU. 663 cases were reviewed, with 14%, 37%, 45% and 3% stage 1, 2, 3 and 4 respectively. Median gestational age at surgery was 21 weeks (IQR = 19–22.5). The overall survival of 0, 1 and 2 twins was 16%, 31% and 53% respectively. The overall median gestational age at delivery was 32.5 weeks (IQR = 28.5–34) and 37.5 weeks (Kaplan-Meier, 95%CI = 36–39) for spontaneous labor. The cumulative incidence of unexpected complications in ongoing pregnancies increased to 32% (Kaplan-Meier, 95%CI = 27–36%) at 35 weeks and was steady onwards. Concurrently, perinatal morbimortality decreased to < 5% at ≥ 34 weeks. Our data does not support elective preterm delivery in otherwise uncomplicated pregnancies treated by FSLC. However, after 36 weeks, our data may be insufficient to safely consider prolonging pregnancies thereafter. Prevention of complications by elective delivery < 34 weeks would increase perinatal morbimortality. Supporting information can be found in the online version of this abstract. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.