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Objectives To investigate the maternal plasma and amniotic fluid (AF) cytokine concentrations in twin pregnancies complicated by TTTS and the effects of fetoscopic laser ablation (FLA). Methods A prospective cohort of MC twins complicated by severe TTTS (n = 23) were studied, between October 2006 and December 2007. Cytokines (TH1: interferon-gamma (IFN-g), tumour necrosis factor-α (TNF-α) and interleukins (IL-2, IL-6, IL-8, IL-12, IL-1β); TH2: IL-4, IL-5, IL-10 and IL-13; as well as keratinocyte growth factor (KGF), platelet derived growth factor-BB (PDGF-BB), fibroblast growth factor-basic (FGF-basic), tissue inhibitor of matalloproteinases-1 (TIMP-1) and intercellular adhesion molecule-1 (ICAM-1) were measured in plasma and AF before and after FLA by Human TH1/TH2/Human Angiogenesis FASTQuant kits or ELISA. Results There was a significant difference in the plasma PDGF-bb and TIMP-1 concentrations noted between uncomplicated MC and MC twin pregnancies complicated by TTTS. Median maternal plasma PDGF-bb was lowest in uncomplicated MC twins than in TTTS pregnancies and DC twin pregnancies pg/ml) (P = 0.0486). However, TIMP-1 was higher in TTTS pregnancies than in uncomplicated twins (P = 0.0031). There was a significant difference between plasma and amniotic fluid concentrations of IL-6, IL-1b, TNF-a, IL-10, IL-4, IL-8, IFN-γ, TIMP-1 and ICAM-1. There were no significantly differences in either plasma or amniotic fluid cytokines after fetoscopic laser ablation. Conclusion TTTS is associated with minimal changes in cytokine levels although the majority of cytokine levels were higher in amniotic fluid than maternal blood. It does not appear that FLA provokes a significant cytokine response.

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