Prise en charge des grossesses monochoriales biamniotiques réunionnaises avec indication de transfert in utero

Abstract

ObjectiveComplicated monochorionic biamniotic (MCBA) twin pregnancies may require treatment with fetoscopic laser photocoagulation, in case of Twin Oligo-Polyhydramnios Sequence or need of a selective termination of pregnancy. Patients requiring these treatments would need medical transfer to Metropolitan France because these are unavailable in Réunion Island. We evaluated the outcomes of MCBA pregnancies in Reunion Island with indications for fetoscopy, with a view to discussing the interest of training doctors on the Reunion Island, to practice fetoscopy on site. Materials and methodsRetrospective hospital study running from 2015 to 2018. We included all MCBA pregnancies between 15 and 25 weeks of gestation, with indications for in utero transfer. Our objective was to examine whether and why they were transferred and pregnancy outcomes. ResultsOf the 23 patients, 17 (73.9%) benefited from sanitary transfers. The survival rate of the fetuses in 15 pregnancies with Twin Oligo-Polyhydramnios Sequence (TOPS) was 73.3% for one twin and 53.3% for both twins. For the eight cases of Selective Termination of the pregnancy (ST), the survival rate of the twin was better with a transfer (n=5/6, 83.3%) than without a transfer (n=1/2 or 50%). The rate of premature rupture of the membranes after sanitary transfer among patients with TOPS was 63.6%. ConclusionThe sanitary transfer allows the management in expert center of complicated MCBA twin pregnancies, but is not always feasible and is accompanied by a high rate of premature ruptures of membranes.