Decrease in High Human Chorionic Gonadotropin in Twin-Twin Transfusion Syndrome following Fetoscopic Laser Surgery

Abstract

Introduction: The purpose of this study was to investigate the concentration of maternal serum human chorionic gonadotropin (hCG) in twin-twin transfusion syndrome (TTTS) before and after fetoscopic laser surgery and to clarify the association between TTTS and hCG. Material and Methods: The concentration of maternal serum hCG was measured before fetoscopic laser surgery and 2 and 4 weeks after laser surgery in 120 patients diagnosed with TTTS. Results: The preoperative serum concentration of hCG was 6.34 multiples of the median (MoM; interquartile range 3.52–9.86). The concentration of hCG was higher in TTTS of Quintero stage III or IV (7.17 MoM, range 4.21–11.0) compared to stage I or II (3.37 MoM, range 2.35–7.74). When laser surgery for TTTS was effective, hCG gradually decreased to less than half the preoperative concentration 2 weeks after laser surgery, and the concentration was further reduced to within the normal range at 4 weeks. However, the concentration of hCG in 3 cases with TTTS recurrence did not decrease. Discussion: A close association was observed between the concentration of hCG and the condition of TTTS. A change in the concentration of hCG after laser surgery could be a useful marker to judge the effectiveness of laser surgery in TTTS.

Relapse of Human Chorionic Gonadotropin-Induced Hyperthyroidism and Severe Hyperemesis Gravidarum Secondary to Twin-Twin Transfusion Syndrome, With Rapid Recovery Following Fetoscopic Laser Coagulation: Case Report

“…The most likely mechanisms are the large placental volume and placental hypoxia secondary to uteroplacental blood flow disruption by the polyhydramnios surrounding the recipient fetus (8). Successful treatment of TTTS with FLC of placental vascular anastomoses led to decrease and then normalization of hCG levels by 2 and 4 weeks, respectively (11). The observations in the present case are consistent with these data.…”

Recurrent twin–twin transfusion syndrome after selective fetoscopic laser photocoagulation: a systematic review of the literature

“…However, this review included both selective and non‐selective FLP and these fetoscopic techniques are associated with differing rates of recurrence. Furthermore, since 2007, several authors have reported outcomes following SFLP for TTTS. Here we present a systematic review of the incidence and management of recurrent TTTS after SFLP.…”

Change of maternal thyroid function in twin-twin transfusion syndrome

“…The laser therapy was performed as described in a previous report [15]. We excluded the some cases in which a single or double fetal death occurred after laser therapy, and recurrent cases of TTTS with polyhydramnios/oligohydramnios, because fetal death itself can lead to a decrease in hCG, and the recurrence of TTTS did not cause a decrease in hCG, as has been previously reported [9].…”

“…It has been reported that elevated maternal serum hCG is seen in TTTS, and that there is a close association between hCG elevation and TTTS [8]. The change in the value of hCG after laser therapy may be a marker of laser therapy efficacy [9].…”