P29.04: The roles of superficial anastomoses with Twin–twin transfusion syndrome

Abstract

The roles of superficial anastomoses with Twin–twin transfusion syndrome (TTTS) are previously reported. Arterio-arterial (AA) anastomoses may rescue a blood transfusion due to blood pressure imbalance between both twins, however, the roles of veno-venous (VV) anastomoses remain still unclear. The aim of this study was to evaluate whether vascular anastomoses affect intrauterine fetal death (IUFD) after laser surgery. All TTTS patients underwent laser surgery from 2005 to 2012 were included in this study. We described vascular anastomoses, umbilical cord insertion abnormalities (velamentous or marginal), abnormal waveforms of fatal Doppler and how to coagulate in laser surgery. We analysed risk factors for IUFD. A total of 129 TTTS placentas were analysed (IUFD of donor, n=29: IUFD of recipient, n=12: double IUFD, n=3: both alive, n=91). The prevalence of AA anastomoses was higher in the IUFD of donor than in the control (p<0.001). Multiple logistic analysis revealed the prevalence of AA anastomoses, gestational age of laser surgery and anterior placenta were independent risk factors for IUFD of donor after laser surgery. The prevalence of VV anastomoses was higher in the IUFD of recipient and double IUFD than in the control (p=0.032, 0.004). AA anastomoses have relation to IUFD of donor after laser surgery and may protective hypovolemic of donor. VV anastomoses are detected frequently in IUFD of recipient and double IUFD placentas after laser surgery and may rescue recipient or both fetuses.