BACKGROUND
Twin-twin transfusion syndrome (TTTS) and selective fetal growth restriction (sFGR) are among the most common specific complications of monochorionic diamniotic (MCDA) twins. According to the general opinion, the only one pathogenetically justified treatment for TTTS is fetoscopic laser coagulation of anastomoses (FLCA). The presence of sFGR before fetoscopy can influence both the outcome of the operation itself and the prognosis of the further course of pregnancy. To present day it is still debatable whether FLCA affects the further growth of the donor fetus.
OBJECTIVE
To evaluate the effect of sFGR on the short-term and long-term outcomes of pregnancy with monochorionic twins complicated by TTTS after FLCA.
MATERIAL AND METHODS
A retrospective study included 216 patients with monochorionic diamniotic (MCDA) twins, who underwent FLCA at 15-25 weeks of gestation. Fetoscopies were performed from 2005 to 2020 under epidural anesthesia using endovideoscopic equipment and Karl Storz instruments; the source of laser radiation was a Dornier surgical laser. Depending on the presence of concomitant sFGR, the patients were divided into two groups: the TTTS group (n=139) and the TTTS+sFGR group (n=77). Patients of both groups were compared in terms of perinatal outcomes, early antenatal death of the fetus/es (within 24 hours after laser exposure), neonatal mortality (28 days after birth).
It was revealed that more than a third (35.6%) of TTTS is combined with IGRP. Patients with a combination of TTTS and sFGR were more often operated on at the later stages of TTTS according to the R.A. Quintero classification. The combination of sFGR and TTTS adversely affects perinatal outcomes: the probability of death of the donor is significantly higher (32.5% with TTTS+sFGR versus 5.7% with isolated TTTS). When studying the angioarchitectonics of the placentas, it was revealed that AA-anastomoses were more often present in the TTTS+sFGR group. Logistic regression analysis showed that the male sex of the fetus and the sheath or marginal location of the umbilical cord in the donor fetus are independent risk factors for reduced perinatal survival of the donor fetus with TTTS+sFGR.
Our data indicate a complex relationship between the pathophysiology of TTTS and sFGR, occurring due to the uneven distribution of blood flow and the peculiarities of the angioarchitectonics of the placenta. It was also found that TTTS with concomitant sFGR is associated with a more severe outcome and a decrease in perinatal donor survival.
