Perinatal outcomes after laser photocoagulation of anastomoses in monochorionic pregnancies

To describe the perinatal outcomes of monochorionic pregnancies complicated with twin-to-twin transfusion syndrome, laser photocoagulation of placental anastomoses was presented as an initial experience in a reference center in South Brazil.

Case series between October 2020 and March 2024, including monochorionic twin/triplet pregnancies complicated with twin-to-twin transfusion syndrome. This syndrome was classified according to Quintero's stage. The maternal and surgical characteristics, as well as the perinatal outcomes were assessed.

Of the 17 pregnant women diagnosed with twin-to-twin transfusion syndrome, 11 (64.7%) were treated at our center, including 9 monochorionic-diamniotic, 1 dichorionic-triamniotic, and 1 monochorionic-diamniotic triplet. Of the 9 laser ablations of placental anastomoses included in the study, 8 (88.9%) had 2 or more live births, and 1 (11.1%) had no live births. The mean gestational age at surgery was 21.9 weeks. Regarding Quintero stage at the time of surgery, 2 were stage I, 3 were stage II, and 4 were stage IV. The interval between surgery and delivery was 10.8 weeks, with a mean gestational age at delivery of 32.7 weeks. The mean birth weight of the recipient was 1,845 g, and that of the donor was 1,667.8 g.

Our initial experience with laser ablation of placental anastomoses in monochorionic pregnancies complicated by twin-to-twin transfusion syndrome showed good perinatal outcomes with lower complication rates.