(46.7% vs. 19.0%, P < 0.001), IUFD (43.3% vs. 25.8%, P < 0.05) and PABS (13.3% vs. 1.0%, P < 0.001

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Background Due to the progressive nature of twin-to-twin transfusion syndrome (TTTS), hindering on health care access during the coronavirus disease (COVID-19) pandemic may lead to delayed diagnosis and referral to fetal surgery centers, which may have repercussions on outcomes. Objective To assess the clinical impact of the COVID-19 pandemic on pregnancies complicated with TTTS. Study Design A retrospective cohort of consecutive monochorionic diamniotic twin pregnancies complicated with TTTS evaluated in our national referral fetal surgery center at Queretaro, Mexico for possible surgical fetoscopy was constructed. Maternal-fetal characteristics and perinatal outcomes of cases evaluated during the first year of the World Health Organization's COVID-19 pandemic declaration (11 March 2020- 10 March 2021) were retrospectively compared with cases evaluated during the same period in the previous year (11 March 2019 – 10 March 2020). Results 109 consecutive TTTS cases were evaluated during the 2-year study period, 54 during the COVID-19 pandemic and 55 in the previous year. In the former group, a higher proportion of cases with fetal surveillance interval longer than 2 weeks (70.4% vs. 47.3%, p=0.01), TTTS complications precluding laser therapy such as intrauterine fetal demise, preterm rupture of membranes, or cervical dilatation with prolapsed amniotic membranes (18.5% vs. 1.8%, p<0.01), advanced TTTS (53.7% vs. 36.4%, p=0.07), preoperative short cervix (25.9% vs. 10.9%, p<0.05), and lower overall perinatal survival (56.9% vs. 80.0%, p=0.01 of at least one twin; and 39.2% vs. 56.4%, p=0.08 of both twins, respectively) were observed. A significantly lower number of cases were selected for fetoscopic laser therapy during the pandemic period (75.9% vs. 92.7%, p=0.01), with similar postoperative outcomes seen in both study periods. Conclusion In pregnancies with TTTS, the COVID-19 pandemic has shown an adverse impact involving suboptimal fetal surveillance, advanced stages at diagnosis, poorer survival rates, and higher number of complications that preclude fetoscopic laser therapy.