Intrauterine fetal demise following laser treatment in twin-to-twin transfusion syndrome

Objective To evaluate the incidence, risk factors and consequences of intrauterine fetal demise (IUFD) of at least one twin in twin-to-twin transfusion syndrome (TTTS) treated by laser. Design Retrospective analysis. Setting Experience of a single centre between 1999 and 2004. Population A subgroup of 45 cases with fetal demise of one or both twins from a series of 120 cases of TTTS treated by laser. Methods All cases were entered prospectively into a dedicated database and the results were analysed retrospectively. Main outcome measures Fetal demise prognostic factors, survival, fetal anaemia, brain lesions, neonatal death and intact survival. Results IUFD of one twin occurred in 40 of 120 cases (19 donors and 21 recipients). IUFD of both twins occurred in another five cases. From these 40 cases, miscarriage occurred in two and pregnancy termination was requested in another two cases because of antenatal brain lesions. Two neonates died and two presented severe morbidity, survivors were therefore neurologically normal at 6-44 months of life in 89% (32/36) of the cases. Univariate analysis showed that preoperative abnormal umbilical artery Doppler in the donor before laser treatment and in the recipient following laser treatment was associated with their demise. Incomplete coagulation was suspected in cases where anaemia or cerebral lesions developed following the death of the first twin (10). Conclusions IUFD of one or both twins occurred in 45 of 120 (38%) cases of severe TTTS treated by laser. In these, separation of the placental circulations was incomplete in at least 22% (10/45) of the cases. Umbilical artery Doppler abnormalities before laser were found to be risk factors for the donors' demise following the procedure.