Donor Death After Selective Fetoscopic Laser Surgery for Twin–Twin Transfusion Syndrome

Abstract

III.

Fetal Doppler changes 1 week after endoscopic equatorial laser for twin‐to‐twin transfusion syndrome: A longitudinal study

“…The preoperative finding of umbilical artery AREDF in TTTS donors can be considered as a sign of severe hypovolemia, placental insufficiency, or both . The coexistence of severe FGR was found to be an additional risk factor of donor's demise in previous studies . Our data showed that, among donors surviving at 1 week after laser treatment, the incidence of FGR was similarly high in the group with Doppler normalization and in cases with persistently abnormal findings (Table ), and that in 68% of growth restricted donors with prelaser Doppler abnormalities, there was normalization after treatment, suggesting a hypovolemic cause of preoperative findings in these cases more than a hypoxic mechanism.…”

The value of echocardiography and Doppler in the prediction of fetal demise after laser coagulation for TTTS: A systematic review and meta‐analysis

“…An elevated MCA‐PSV in the donor almost doubled the risk of demise, but this finding did not reach significance (OR 1.91, 95% CI, 0.97‐3.76). Three studies reported the odds of donor demise for AEDF and REDF in the UA separately . All three studies concluded that REDF in the UA was the strongest predictor of donor demise.…”

“…It reflects both placental insufficiency (maldevelopment and unequal sharing) and fetal hypotension secondary to the hemodynamic imbalance in TTTS. Three studies showed that REDF in the UA is a stronger predictor of donor IUFD than AEDF . It is suggested that reversed UA flow reflects placental insufficiency in a greater degree and that it is not amenable to improvement following restoration of volume status .…”

“…Half of the reports are retrospective studies. In all but one study selective coagulation was used for all or for a proportion of cases. It is known that incomplete laser coagulation is a risk factor for recurrent TTTS or post‐laser TAPS and therewith for possible subsequent fetal demise .…”

Perinatal outcomes of single fetal survivor after fetal intervention for complicated monochorionic twins

“…In TTTS, donor demise is more common than recipient demise following FLP. Several risk factors for postprocedure donor fetal demise have been identified, including fetal growth discordance greater than 30%, reverse end‐diastolic velocity in the donor umbilical artery, marginal or velamentous cord insertion, or increased number of anastomoses …”