Abstract
twin-to-twin transfusion syndrome (TTTS), defined by combination of polyhydramnios-oligohydramnios, is the most prevalent (5%-35%) of the abnormalities due to placental vascular anastomoses and the most lethal (80%-100% mortality) if untreated. Fetoscopic laser ablation of abnormal vasculature using the Solomon technique is the gold standard approach. It consists of interrupting the intertwin blood flow. to present our initial experience at the Fetal Surgery Service of the Hospital de Clinicas of the Federal University of Parana (HC-UFPR) and to compare our results with those reported in the literature. we conducted a retrospective analysis of pregnancies who had undergone laser ablation, assessing data on Quintero's staging, gestational age at diagnosis and at the time of the procedure, placental position, immediate post-procedure survival, and survival after the neonatal period. We then compared these data with the most recent data available in the literature. we analyzed ten TTTS cases. The diagnosis was performed before the 26th week of pregnancy (median 20.8 weeks) and treatment occurred in a median of 9.5 days later. The distribution by the Quintero's staging was of three cases in stage II, five in stage III, and two in stage IV. In 50% of the gestations, at least one of the fetuses survived through the neonatal period. the treatment of TTTS in the HC-UFPR had a positive impact in the survival of the affected fetuses, although the results were worse than the ones reported in the literature, probably due to the delay in referencing the patients to our service, leading to a prolonged interval between diagnosis and treatment.
Highlights
Twin pregnancies often impose risks on mother and fetuses when compared with non-twin ones[1]
The forms of presentation of these conditions are: twin-twin transfusion syndrome (TTTS), whose incidence in monochorionic pregnancies varies between 5% and 35%; intrauterine growth restriction (IUGR), between 10% and 15%5; twin anemia-polycythemia sequence (TAPS), in 5%6; and twin reverse arterial perfusion sequence (TRAPS) – known as an acardiac twin – in 1%1
For the purposes of this study, we limited the series to patients treated by TTTS, with a confirmed ultrasonographic diagnosis at the HC-UFPR, and undergoing laser ablation via fetoscopy in this service
Summary
Twin pregnancies often impose risks on mother and fetuses when compared with non-twin ones[1]. One of the reasons for this is the almost always present vascular anastomoses[3], which allow the shunting of blood between fetuses[4] and can lead to the development of a group of pathophysiological conditions commonly referred to as “complicated monochorionic twins”[5]. The forms of treatment include amnioreduction, septostomy, selective feticide, and laser ablation of placental anastomoses via fetoscopy[2]. The latter is considered the current treatment of choice when TTTS occurs before 26 weeks of gestation[2], as it displays the lowest neurological sequelae and the highest survival rates[7,8]. Treatment consists of preventing blood flow between the fetuses by coagulating the abnormal vessels that connect them
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