Foetoscopic Laser Management of Triplet Pregnancies Complicated by Twin-Twin Transfusion Syndrome
Evangelia Vlachodimitropoulou1, Sidika Naz Dagli2, Grace Ng Yang Huang3
1Ontario Fetal Centre, Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada, evangelia.vlachodimitropoulou@sinaihealth.ca.
Introduction:
Twin-twin transfusion syndrome (TTTS) may complicate triplet pregnancies with a monochorionic component; however, data on foetoscopic laser ablation (FLA) in this setting remain limited. This study evaluated perinatal outcomes in TTTS-affected triplet pregnancies with at least one monochorionic placenta treated with FLA and compared these with monochorionic diamniotic (MC/DA) twin pregnancies.
Methods:
We retrospectively reviewed 42 triplet pregnancies complicated by TTTS treated with FLA. Of these, 25 were dichorionic triamniotic (DC/TA, 59.5%) and 17 were monochorionic triamniotic (MC/TA, 40.5%). Antenatal, procedural, and neonatal outcomes were compared with those of 1,072 MC/DA twin pregnancies treated with FLA at the same centre. Categorical and continuous variables were compared using the chi-square/Fisher's exact test and Mann-Whitney U test, respectively, with p < 0.05 considered statistically significant. Proportions are presented with 95% confidence intervals, and subgroup analyses were considered exploratory.
Result:
Quintero stage distribution did not differ significantly between cohorts, and gestational age (GA) at FLA was 20.3 weeks (IQR 18.7-22.3) in triplets and 20.4 weeks (IQR 18.4-23.1) in twins. Procedural complications in triplets were infrequent and did not differ significantly from twins. PPROM rates and laser time did not differ significantly. Survival of unaffected triplet was 88.1%. Among TTTS-affected pairs within triplets, dual neonatal survival was 61.9%, with at least one survivor in 85.7%. Dual survival was more frequent in MC/TA (70.6%) than in DC/TA (56.0%) triplets. Survival outcomes were not statistically different from those of MC/DA twins (dual: 70.1%, at least one 91.6%). The median GA at delivery was 31.8 weeks in triplets and 32.3 weeks in twins.
Conclusions:
Triplet pregnancies with TTTS treated with FLA showed no statistically significant differences in antenatal and neonatal outcomes to MC/DA twins, with high survival rates and low complication rates reported.
