Fetoscopic Laser Photocoagulation for Stage II TTTS in a Resource-Limited Setting: A Case Report on the Persisting
Moch Erwin Jaya Sanjaya1, Dennis Fachmi Ardiansyah1, Bahar Sangkur Gusasih1
1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Padjadjaran University/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
Background:
Twin-to-Twin Transfusion Syndrome (TTTS) is a severe complication in monochorionic pregnancies. Fetoscopic laser photocoagulation (FLPC) is the standard of care for advanced stages. However, data regarding neonatal outcomes following FLPC in resource-limited settings, where neonatal intensive care capabilities may be constrained, remain scarce.
Case Presentation:
We report the case of a 33-year-old woman (G4P2A1) diagnosed with TTTS Quintero stage II at 21 weeks of gestation. She presented with significant pre-existing uterine contractions. Following a decompressive amnioreduction, she underwent selective FLPC which successfully resolved the "stuck twin" phenomenon in the donor twin. Despite the technical success of the fetal intervention, the patient experienced worsening preterm labor resulting in delivery at 24 weeks and 4 days. Both infants were born alive but succumbed to complications of extreme prematurity given the limited availability of advanced neonatal life support.
Conclusion:
This case highlights the critical need for strategies to mitigate iatrogenic prematurity following successful fetal therapy in resource-limited settings. While FLPC effectively corrects fetal pathophysiology, the ultimate survival is heavily dependent on the capacity of the healthcare system to manage the subsequent extreme prematurity.
