Complications of fetoscopic laser coagulation of placental anastomosis in twin-to-twin transfusion syndrome

Gladkova K.A.; Sakalo V.A.; Frolova E.R.; Kostyukov K.V.; Khodzhaeva Z.S.

doi:https://doi.org/10.17116/repro20243005155

Gladkova K.A.

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

ORCID: 0000-0001-8131-4682

Sakalo V.A.

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

ORCID: 0000-0002-5870-4655

Frolova E.R.

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

ORCID: 0000-0003-2817-3504

Kostyukov K.V.

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

ORCID: 0000-0003-3094-4013

Khodzhaeva Z.S.

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

ORCID: 0000-0001-8159-3714

Complications of fetoscopic laser coagulation of placental anastomosis in twin-to-twin transfusion syndrome

Authors:

Gladkova K.A., Sakalo V.A., Frolova E.R., Kostyukov K.V., Khodzhaeva Z.S.

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Journal: Russian Journal of Human Reproduction. 2024;30(5): 55‑63

DOI: 10.17116/repro20243005155

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To cite this article:

Gladkova KA, Sakalo VA, Frolova ER, Kostyukov KV, Khodzhaeva ZS. Complications of fetoscopic laser coagulation of placental anastomosis in twin-to-twin transfusion syndrome. Russian Journal of Human Reproduction. 2024;30(5):55‑63. (In Russ.)
https://doi.org/10.17116/repro20243005155

Подписка 2026 Проблемы репродукции (Russian Journal of Human Reproduction)

Использование инфографики авторами научных работ

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Abstract:

Twin-to-twin transfusion syndrome (TTTS) is a serious complication for both fetuses occurring in 10—15% of monochorionic multiple pregnancies with various placental complications, including hypoxia, anemia, increased oxidative stress, and ischemia-reperfusion injury. Being minimally invasive surgical procedure fetoscopic laser coagulation of vascular anastomoses is the treatment of choice dramatically improves the survival rates in twin-to-twin transfusion syndrome.

OBJECTIVE

To study the frequency and structure of complications of fetoscopic laser coagulation of placental anastomoses in TTTS.

MATERIAL AND METHODS

A retrospective study of 258 monochorionic pregnancies complicated by TTTS which underwent laser coagulation of placental anastomoses in 2013—2021 years.

RESULTS

Fetoscopic laser coagulation of anastomoses (FLC) has complications that occur during the surgery or postoperative period. The rate of pregnancy loss after FLC is 8.5%. The overall survival rate directly correlates with the stage of FLC. The Solomon technique supports to reduce the recurrence of TTTS (9.5%), postoperative TAPS (twin anemia polycythemia sequence), the incidence of which was 2.3%.

CONCLUSIONS

Laser coagulation of placental vascular anastomoses improves perinatal outcomes in monochorionic twin pregnancies. The postoperative complications does not depend of stage twin to twin transfusion syndrome, the technical comlexity of anastomosis visualization and volume of amnioreduction. Coagulation of vascular anastomoses of the placenta through the shell of the donor fetus increases the risk of dissection of the fetal membranes and premature discharge of amniotic fluid.

Keywords:

twin to twin transfusion syndrome

complications twin pregnancy

monochorionic twin pregnancy

fetoscopic laser coagulation

fetal medicine

Authors:

Gladkova K.A.

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

ORCID: 0000-0001-8131-4682

Sakalo V.A.

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

ORCID: 0000-0002-5870-4655

Frolova E.R.

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

ORCID: 0000-0003-2817-3504

Kostyukov K.V.

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

ORCID: 0000-0003-3094-4013

Khodzhaeva Z.S.

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

ORCID: 0000-0001-8159-3714

Received:

15.09.2023

Accepted:

06.10.2023

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References:

Diehl W, Diemert A, Hecher K. Twin-twin transfusion syndrome: Treatment and outcome. Best Practice and Research Clinical Obstetrics and Gynaecology. 2014;28(2):227-38. https://doi.org/10.1016/j.bpobgyn.2013.12.001
Shanahan MA, Bebbington MW. Placental Anatomy and Function in Twin Gestations. Obstetrics and Gynecology Clinics of North America 2020;47(1):99-116. https://doi.org/10.1016/j.ogc.2019.10.010
Murgano D, Khalil A, Prefumo F, Mieghem TV, Rizzo G, Heyborne KD, Melchiorre K, Peeters S, Lewi L, Familiari A, Lopriore E, Oepkes D, Murata M, Anselem O, Buca D, Liberati M, Hack K, Nappi L, Baxi LV, Scambia G, Acharya G, D’Antonio F. Outcome of twin‐to‐twin transfusion syndrome in monochorionic monoamniotic twin pregnancy: systematic review and meta‐analysis. Ultrasound Obstetrics and Gynecology. 2020;55(3):310-317. https://doi.org/10.1002/uog.21889
Gheorghe CP, Boring N, Mann L, Donepudi R, Lopez SM, Chauhan SP, Bhandari V, Moise KJ Jr, Johnson A, Papanna R. Neonatal Outcomes and Maternal Characteristics in Monochorionic Diamniotic Twin Pregnancies: Uncomplicated versus Twin-to-Twin Transfusion Syndrome Survivors after Fetoscopic Laser Surgery. Fetal Diagnosis and Therapy. 2020;47(2):165-170. https://doi.org/10.1159/000500858
D’Antonio F, Benlioglu C, Sileo FG, Thilaganathan B, Papageorghiou A, Bhide A, Khalil A. Perinatal outcomes of twin pregnancies affected by early twin-twin transfusion syndrome: A systematic review and meta-analysis. Acta Obstetricia et Gynecologica Scandinavica. 2020;99(9):1121-1134. https://doi.org/10.1111/aogs.13840
Slaghekke F, Lewi L, Middeldorp JM, Weingertner AS, Klumper FJ, Dekoninck P, Devlieger R, Lanna MM, Deprest J, Favre R, Oepkes D, Lopriore E. Residual anastomoses in twin-twin transfusion syndrome after laser: the Solomon randomized trial. American Journal of Obstetrics and Gynecology. 2014;211(3):285.e1-285.e7. https://doi.org/10.1016/j.ajog.2014.05.012
Quintero RA, Morales WJ, Allen MH, Bornick PW, Johnson PK, Kruger M. Staging of twin-twin transfusion syndrome. Journal Perinatology. 1999;19(8 Pt 1):550-555. https://doi.org/10.1038/sj.jp.7200292
Cruciat G, Nemeti GI, Popa-Stanila R, Florian A, Goidescu IG. Imaging diagnosis and legal implications of brain injury in survivors following single intrauterine fetal demise from monochorionic twins — a review of the literature. Journal of Perinatal Medicine. 2021;49(7):837-846. https://doi.org/10.1515/jpm-2020-0566
Kostyukov KV, Gladkova KA, Sakalo VA, Shmakov RG, Tetruashvili NK, Gus AI. Fetal Medicine: Literature Review and the Experience of V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine. Doctor.Ru. 2019; 11(166):35-43. (In Russ.). https://doi.org/10.31550/1727-2378-2019-166-11-35-43
Mustafa HJ, Javinani A, Goetzinger K, Aghajani F, Harman C, Shamshirsaz AA, Sanz Cortes M, Donepudi RV, Krispin E, Nassr AA, Espinoza J, Belfort MA, Turan OM. Single fetal demise following fetoscopic ablation for twin-to-twin transfusion syndrome — cohort study, systematic review, and meta-analysis. American Journal of Obstetrics and Gynecology. 2022;226(6):843.e1-843.e28. https://doi.org/10.1016/j.ajog.2022.02.035
Kweon SY, Lee SM, Cho K, Park CW, Park JS, Jun JK. Fetal Survival Immediate after Fetoscopic Laser Ablation in Twin to Twin Transfusion Syndrome. Journal of Korean Medical Sciense. 2019; 34(3):e20. https://doi.org/10.3346/jkms.2019.34.e20
Zhang LY, Wei X, Zou G, Yang YJ, Zhou FH, Chen JP, Zhou Y, Sun LM. Perioperative maternal complications of twin-twin transfusion syndrome after fetoscopic laser photocoagulation. Zhonghua Fu Chan Ke Za Zhi. 2020;55(12):823-829. https://doi.org/10.3760/cma.j.cn112141-20200821-00656
Takano M, Nakata M, Murata S, Sumie M, Morita M. Chorioamniotic Membrane Separation after Fetoscopic Laser Photocoagulation. Fetal Diagnosis and Therapy 2018;43(1):40-44. https://doi.org/10.1159/000472713
Bergh EP, Moise KJ Jr, Johnson A, Papanna R. Pregnancy outcomes associated with chorioamnion membrane separation severity following fetoscopic laser surgery for twin‐twin transfusion syndrome. Prenatal Diagnosis. 2020;40(8):1020-1027. https://doi.org/10.1002/pd.5725
Li WF, Chao AS, Chang SD, Cheng PJ, Yang LY, Chang YL. Effects and outcomes of septostomy in twin-to-twin transfusion syndrome after fetoscopic laser therapy. BMC Pregnancy Childbirth. 2019;19(1):397. https://doi.org/10.1186/s12884-019-2555-5
Bailleul A, Athiel Y, Gueneuc A, Salomon L. Ultrasound findings in Pseudoamniotic band syndrome after fetoscopic surgery: Antenatal description of three cases and review of literature. Journal of Gynecology Obstetrics and Human Reproduction. 2021;50(9):102178. https://doi.org/10.1016/j.jogoh.2021.102178
Tollenaar LS, Slaghekke F, Middeldorp JM, Klumper FJ, Haak MC, Oepkes D, Lopriore E. Twin Anemia Polycythemia Sequence: Current Views on Pathogenesis, Diagnostic Criteria, Perinatal Management, and Outcome. Twin Research and Human Genetics. 2016;19(3): 222-233. https://doi.org/10.1017/thg.2016.18
D’Antonio F, Herrera M, Oronzii L, Khalil A. Solomon technique vs selective fetoscopic laser photocoagulation for twin—twin transfusion syndrome: systematic review and meta‐analysis of maternal and perinatal outcomes. Ultrasound Obstetrics and Gynecology. 2022;60(6):731-738. https://doi.org/10.1002/uog.26095
Slaghekke F, Lopriore E, Lewi L, Middeldorp JM, van Zwet EW, Weingertner AS, Klumper FJ, DeKoninck P, Devlieger R, Kilby MD, Rustico MA, Deprest J, Favre R, Oepkes D. Fetoscopic laser coagulation of the vascular equator versus selective coagulation for twin-to-twin transfusion syndrome: An open-label randomised controlled trial. Lancet. Elsevier Ltd. 2014;383(9935):2144-2151. https://doi.org/10.1016/S0140-6736(13)62419-8
Van Der Veeken L, Couck I, Van Der Merwe J, De Catte L, Devlieger R, Deprest J, Lewi L. Laser for twin-to-twin transfusion syndrome: a guide for endoscopic surgeons. Facts, Views and Vision in ObGyn. 2019;11(3):197-205.
Stefanescu BI, Adam AM, Constantin GB, Trus C. Fetal Demise in Twin Pregnancy — A Great Concern but Still a Favorable Outcome. Diseases. 2021;9(2):33. https://doi.org/10.3390/diseases9020033
Huber A, Diehl W, Bregenzer T, Hackelöer BJ, Hecher K. Stage-related outcome in twin-twin transfusion syndrome treated by fetoscopic laser coagulation. Obstetrics & Gynecology. 2006;108(2): 333-337. https://doi.org/10.1097/01.AOG.0000225945.17022.6b
Sago H, Hayashi S, Saito M, Hasegawa H, Kawamoto H, Kato N, Nanba Y, Ito Y, Takahashi Y, Murotsuki J, Nakata M, Ishii K, Murakoshi T. The outcome and prognostic factors of twin-twin transfusion syndrome following fetoscopic laser surgery. Prenatal Diagnosis. 2010;30(12-13):1185-1191. https://doi.org/10.1002/pd.2647