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Q&A

Fetus

Poster Session 3

(726) Outcomes of fetoscopic laser surgery for twin-twin transfusion syndrome according to the presenting twin.

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary & Presenting Author(s)

  • Eric P. Bergh, MD

    Assistant Professor
    McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
    Houston, TX, United States

    • Coauthor(s)

  • Jimmy Espinoza, MD, MSc (he/him/his)

    Professor
    McGovern Medical School at the University of Texas Health Science Center Houston, The Fetal Center- Children’s Memorial Hermann Hospital
    Houston, TX, United States

  • Sami Backley, MD

    Clinical Fellow PGY 8
    McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
    Houston, TX, United States

  • Ramesha Papanna, MD, MPH

    Professor
    McGovern Medical School at UTHealth Houston
    Houston, TX, United States

  • Anthony Johnson, DO

    Professor
    McGovern Medical School at UTHealth Houston
    Houston, TX, United States

Objective: The major complications of fetoscopic laser surgery (FLS) for advanced twin-twin transfusion syndrome (TTTS) are prelabor premature rupture of membranes (PPROM) and preterm birth. We hypothesize that rupture of the amniotic sac of the recipient twin may present differently when a donor twin amniotic sac covers the cervical canal. We examined the incidence and complications of PPROM in patients who underwent FLS for TTTS according to the presenting twin.

Study Design: This is a prospective observational cohort study of 660 monochorionic-diamniotic pregnancies with TTTS who underwent FLS, performed at a single institution during 2011-2022. PPROM was defined as leakage of amniotic fluid documented prior to 34 weeks gestation. Study groups were assigned according to the presenting twin, either donor (D) or recipient (R). Baseline characteristics, gestational age (GA) at delivery and neonatal outcomes were compared between the two groups.

Results:

There were 204 cases with a D-presenting twin and 456 cases with a R-presenting twin. Baseline characteristics were similar between groups. The GA at FLS, incidence of PPROM, and GA at delivery were similar between the groups. The gestational age at PPROM was significantly later when the donor was presenting (median GA 28.6 weeks versus 27.0 weeks, p = 0.028). Among patients managed expectantly, there was no difference in GA at delivery nor was there any difference in twin survival or short-term neonatal outcomes between the groups.

Conclusion: FLS is associated with similar incidence of PPROM although PPROM occurs at a later GA when the donor twin is presenting, with similar GA at delivery than cases where recipient twin in presenting. This finding may represent a ‘plugging’ effect of the donor amniotic sac and should be considered when counseling patients undergoing FLS.