Maternal pulmonary oedema during foetoscopic surgery.

Area of Science:

• Maternal-fetal medicine
• Surgical complications
• Perinatal care

Background:

• Twin-twin transfusion syndrome (TTTS) affects 10-20% of monochorionic twin pregnancies.
• Untreated severe TTTS has a mortality rate up to 90%.
• Foetoscopic laser ablation is a primary treatment for pre-viable TTTS, aiming to ablate vascular anastomoses.

Observation:

• A case of maternal pulmonary edema requiring intubation and ventilation occurred during foetoscopic laser surgery for TTTS.
• Associated hyperchloraemic metabolic acidosis was noted.
• This complication is suspected to be secondary to normal saline irrigation fluid absorption.

Findings:

• Foetoscopic laser ablation improves survival past 28 days and reduces neurological complications compared to serial amnioreduction.
• The procedure involves transabdominal insertion of endoscopes to visualize and ablate anastomotic vessels.
• Maternal complications, though rare, can occur during this intervention.

Implications:

• Highlights the importance of monitoring maternal fluid balance during foetoscopic laser surgery for TTTS.
• Suggests a need for further investigation into the mechanisms of saline absorption and its maternal sequelae.
• Emphasizes the balance between the benefits of laser ablation for TTTS and potential surgical risks.