Effect of Fetoscopic Laser Photocoagulation on Fetal Growth and Placental Perfusion in Twin–Twin Transfusion Syndrome

Yao-Lung Chang; Chin-Chieh Hsu; An-Shine Chao; Shuenn-Dyh Chang; Po-Jen Cheng; Wen-Fang Li

doi:10.3390/jcm11154404

Journal of Clinical Medicine (Jul 2022)

Effect of Fetoscopic Laser Photocoagulation on Fetal Growth and Placental Perfusion in Twin–Twin Transfusion Syndrome

Yao-Lung Chang,
Chin-Chieh Hsu,
An-Shine Chao,
Shuenn-Dyh Chang,
Po-Jen Cheng,
Wen-Fang Li

Affiliations

Yao-Lung Chang: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, College of Medicine, Chang Gung University, 5, Fu-Shin Street, Kweishan, Taoyuan 333, Taiwan
Chin-Chieh Hsu: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, College of Medicine, Chang Gung University, 5, Fu-Shin Street, Kweishan, Taoyuan 333, Taiwan
An-Shine Chao: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, College of Medicine, Chang Gung University, 5, Fu-Shin Street, Kweishan, Taoyuan 333, Taiwan
Shuenn-Dyh Chang: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, College of Medicine, Chang Gung University, 5, Fu-Shin Street, Kweishan, Taoyuan 333, Taiwan
Po-Jen Cheng: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, College of Medicine, Chang Gung University, 5, Fu-Shin Street, Kweishan, Taoyuan 333, Taiwan
Wen-Fang Li: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, College of Medicine, Chang Gung University, 5, Fu-Shin Street, Kweishan, Taoyuan 333, Taiwan

DOI: https://doi.org/10.3390/jcm11154404
Journal volume & issue: Vol. 11, no. 15
p. 4404

Abstract

Read online

Objective: To investigate the fetal growth pattern after fetoscopic laser photocoagulation (FLP) in twin-twin transfusion syndrome (TTTS) and the effect of FLP on placental perfusion and intrauterine growth restriction (IUGR) incidence. Methods: TTTS cases with a live delivery of both twins at least 28 days after FLP and with a neonatal follow-up at our hospital at least 60 days after delivery were included. The biometric data obtained before FLP (based on ultrasound); time point M1), upon birth (M2), and at neonatal follow-up (M3) were analyzed. The body weight discordance (BWD) was defined as (estimated fetal weight [body weight] of the recipient twin − estimated fetal weight [body weight] of the donor twin)/(estimated fetal weight [body weight] of the recipient twin) × 100%. Total weight percentile (TWP) was defined as the donor + recipient twin weight percentile; the TWP indirectly reflected the total placental perfusion. Results: the BWDs decreased from M1 to M2 to M3 (24.6, 15.9, and 5.1, respectively, p p p p = 0.002, LSD test) and increased after delivery, that is, from M2 to M3 (46.8% vs. 63.2%, respectively, p = 0.024, LSD test). The IUGR incidences in donor twins were significantly lower after FLP (77.4% vs. 56.6%, respectively, p = 0.019, McNemar test) and further decreased after delivery (56.6% vs. 37.7%, respectively, p = 0.041, McNemar Test); however, no significant difference was observed in recipient twins’ IUGR incidences among M1, M2, and M3. The donor twin had catch- up growth in body weight, height, and head circumference after delivery, and the recipient twin had catch-up growth in only body height after delivery. Conclusions: the BWD decreased after FLP in fetuses with TTTS mainly because of the decreased weight percentiles of recipient twins. Moreover, it further decreased after delivery mainly because of the increased weight percentiles of donor twins. FLP not only decreased placental perfusion but also improved the TTTS prognosis because of reduced BWD and donor twin IUGR incidence.

Published in Journal of Clinical Medicine

ISSN: 2077-0383 (Online)
Publisher: MDPI AG
Country of publisher: Switzerland
LCC subjects: Medicine
Website: http://www.mdpi.com/journal/jcm

About the journal

Abstract

Keywords