INTRODUCTION

Selective fetoscopic laser coagulation of placental anastomoses is a generally accepted standard in the treatment of Twin-Twin Transfusion Syndrome (TTTS). However, in spite of a steady tendency towards an improvement in the survival rate, the death of the donor fetus after fetoscopic laser coagulation is observed in 13% of cases, and the death of the recipient fetus in 2.6% of cases.

OBJECTIVE

To identify prognostic markers of antenatal fetal death in women with feto-fetal transfusion syndrome after the use of fetoscopic laser coagulation of placental anastomoses at the preoperative stage.

MATERIALS AND METHODS

13 women with feto-fetal transfusion syndrome were examined, whose pregnancy ended in antenatal death of one or two fetuses (group 1), 16 women with TTTS, whose pregnancy ended in the birth of live children (group 2). The comparison group (group 3) included 17 women with monochorionic pregnancy, who, according to ultrasound, did not show complications in the form of TTTS and SZR of the twins. The study of the concentration of endothelin-1, VEGF, PLGF, sEng, metabolites of nitric oxide (NO2^–, NO3^–,) in the peripheral blood was performed by ELISA prior to surgical treatment.

RESULTS

It was found that antenatal fetal death after the use of fetoscopic laser coagulation of placental anastomoses in women with TTTS at the preoperative stage is associated with the development of vasomotor and angiogenic forms of endothelial dysfunction. In this group of women, a decrease in NO₂^– levels was recorded (13.42 (11.08—14.8) versus 15.87 (12.31—19.87) and 18.43 (15.53—23.42) μmol/L in the 2nd and 3rd groups, p_1—3=0.005) and NO₃^– (11.45 (10.41—13.54) versus 15.61 (11.08—18.70) and 15.77 (13,42—20.05) μmol/L, p_1—3=0.039). The concentration of PLGF was also statistically significantly lower (250.14 (206.12—301.62) versus 316.85 (284.71—372.65) and 430.32 (377.0—469.11) pg/ml, p_1—3=0.002 p_1—2=0.028). The VEGF level in women of the 1st group, on the contrary, exceeded the similar indicators of the 3rd group (37.0 (25.8—47.44) versus 29.19 (22.2—44.1) and 25.7 (23.7—28.82) pg/ml, p_1—3 .005). Increased sEnd content was observed in all women with TTTS (9.36 (7.26—10.14 and 9.78 (8.52—10.23) versus 6.97 (5.4—7.53) pg/ml, p_{1—3, 2—3}<0.010), which reflects the presence of an antiangiogenic state characteristic of this pathology.

CONCLUSION

Determination of total NO₂^–, VEGF-A, PLGF in the blood, can serve as additional prognostic markers of antenatal fetal death in women with TTTS at the preoperative stage.